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Intra operative lesion of the pelvic ureter solved in a minimally invasive manner.

Stoica RA, Enache T, Iordache N - J Med Life (2014)

Bottom Line: The rate of recognition of an intra operative ureter lesion is 30% and it could rise up to 90% when cystoscopy with ureteroscopy is used at the end of the intervention.The article presents the case of a 46-year-old patient with uterine fibromatosis, whose pelvic ureter was sectioned during surgery.The lesion was recognised during surgery because, at the end of each intervention, the diuresis was stimulated by injecting Furosemide in order to detect the lesions of the ureters and urinary bladder.

View Article: PubMed Central - PubMed

Affiliation: "Sf. Ioan" Clinical Emergency Hospital, General Surgery Department.

ABSTRACT
Ureteral lesions during open hysterectomy, vaginal hysterectomy or laparoscopic hysterectomy have a rate of 0.2% up to 6%. Multiple complications may occur if the lesion is not recognised intra operatively: hydronephrosis, anuria (bilateral lesion), ureterovaginal fistula, ileus, peritonitis. The rate of recognition of an intra operative ureter lesion is 30% and it could rise up to 90% when cystoscopy with ureteroscopy is used at the end of the intervention. The article presents the case of a 46-year-old patient with uterine fibromatosis, whose pelvic ureter was sectioned during surgery. The lesion was recognised during surgery because, at the end of each intervention, the diuresis was stimulated by injecting Furosemide in order to detect the lesions of the ureters and urinary bladder.

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LigaSure was used to seal the blood vessels but it did not also seal the ureter
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Figure 5: LigaSure was used to seal the blood vessels but it did not also seal the ureter

Mentions: After completing the hysterectomy, extracting the uterus, ovaries and salpinges through the vagina, sealing it, after injecting Furosemide, the presence of a liquid in the pelvic area and a big quantity of "ascites" were noticed. After a thoroughly inspection, the proximal end of the left ureter, whereby urine was leaking discontinuously was discovered (Fig. 5). A trial, without success however, was done to visualise the distal end. Help was asked for from the colleagues in the Urology Unit, who performed a cystoscopy with a catheterisation of both ureters. The exploration certified the integrity of the right ureter and during the catheterisation of the left one, the catheter appeared in the abdominal cavity. The guidance stitch was led in the proximal end of left ureter and a double JJ tube was fixed. Guided by the double JJ tube, a head to head suture of the ureters’ ends with 4 suture points with swaged 4-0 absorbable in a laparoscopic manner was realized (Fig. 6). At the end of the intervention the leak free was checked and 2 drainage tubes were left in the pelvis (Fig. 7).


Intra operative lesion of the pelvic ureter solved in a minimally invasive manner.

Stoica RA, Enache T, Iordache N - J Med Life (2014)

LigaSure was used to seal the blood vessels but it did not also seal the ureter
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233447&req=5

Figure 5: LigaSure was used to seal the blood vessels but it did not also seal the ureter
Mentions: After completing the hysterectomy, extracting the uterus, ovaries and salpinges through the vagina, sealing it, after injecting Furosemide, the presence of a liquid in the pelvic area and a big quantity of "ascites" were noticed. After a thoroughly inspection, the proximal end of the left ureter, whereby urine was leaking discontinuously was discovered (Fig. 5). A trial, without success however, was done to visualise the distal end. Help was asked for from the colleagues in the Urology Unit, who performed a cystoscopy with a catheterisation of both ureters. The exploration certified the integrity of the right ureter and during the catheterisation of the left one, the catheter appeared in the abdominal cavity. The guidance stitch was led in the proximal end of left ureter and a double JJ tube was fixed. Guided by the double JJ tube, a head to head suture of the ureters’ ends with 4 suture points with swaged 4-0 absorbable in a laparoscopic manner was realized (Fig. 6). At the end of the intervention the leak free was checked and 2 drainage tubes were left in the pelvis (Fig. 7).

Bottom Line: The rate of recognition of an intra operative ureter lesion is 30% and it could rise up to 90% when cystoscopy with ureteroscopy is used at the end of the intervention.The article presents the case of a 46-year-old patient with uterine fibromatosis, whose pelvic ureter was sectioned during surgery.The lesion was recognised during surgery because, at the end of each intervention, the diuresis was stimulated by injecting Furosemide in order to detect the lesions of the ureters and urinary bladder.

View Article: PubMed Central - PubMed

Affiliation: "Sf. Ioan" Clinical Emergency Hospital, General Surgery Department.

ABSTRACT
Ureteral lesions during open hysterectomy, vaginal hysterectomy or laparoscopic hysterectomy have a rate of 0.2% up to 6%. Multiple complications may occur if the lesion is not recognised intra operatively: hydronephrosis, anuria (bilateral lesion), ureterovaginal fistula, ileus, peritonitis. The rate of recognition of an intra operative ureter lesion is 30% and it could rise up to 90% when cystoscopy with ureteroscopy is used at the end of the intervention. The article presents the case of a 46-year-old patient with uterine fibromatosis, whose pelvic ureter was sectioned during surgery. The lesion was recognised during surgery because, at the end of each intervention, the diuresis was stimulated by injecting Furosemide in order to detect the lesions of the ureters and urinary bladder.

Show MeSH
Related in: MedlinePlus