Management of urological injuries following gynecologic and obstetric surgery: A retrospective multicenter study.

OBJECTIVE: Urinary system injuries may occur iatrogenically during some surgical procedures especially gynecological and obstetrical surgeries. Unfortunately, these injuries can lead to serious complications in patients. In this multicentric study, we aimed to review and report our experiences and results of urinary tract injuries identified during gynecological and obstetrical surgery. METHODS: We included women with urinary tract injuries during gynecological and obstetrical surgeries between January 2018 and October 2023 at four centers. Detailed data collected include patient demographics, surgical details, injury characteristics, diagnostic and treatment methods, timing of injury diagnosis and management reports of the patients. The incidence of bladder and ureter injuries was evaluated and the rate of intraoperative urological consultations was recorded. RESULTS: In a total of 328 patients with a median age of 47 years (24-90), urinary tract injuries were diagnosed, including 227 (69.2%) iatrogenic bladder injuries (IBI) and 101 (30.8%) iatrogenic ureteral injuries (IUI). These injuries were diagnosed in 299 patients (91.2%) during surgery and in 29 patients (8.8%) after the surgical procedure. We observed intraoperative detection rates of 71.9% for IBI and 28.1% for IUI. IBI (71.9%) was diagnosed significantly more frequently than IUI (28.1%) (p=0.001). Cesarean section resulted in significantly more frequent IBI, whereas tumor debulking surgeries resulted in more IUI (n=52, 56.5%) than the other types of procedures (p<0.001). CONCLUSION: Our study provides a comprehensive overview of iatrogenic urological injuries during gynecological and obstetrical surgeries. Although the bladder is the most frequently injured organ during gynecological and obstetric surgeries, early diagnosis and urological intervention are mandatory to prevent delayed complications. Surgeons must have a thorough understanding of the pelvic anatomy and appropriate surgical techniques to prevent iatrogenic injuries during surgery and ensure timely diagnosis and treatment of urinary tract injuries.

Bilateral ureteral stones; factors affecting treatment decision.

AIM: To evaluate certain factors that may affect the decision-making process for the rational management approach in cases presenting with bilateral ureteral stones. METHODS: A total of 153 patients presenting with bilateral ureteral stones from 6 centers were evaluated and divided in three groups. Group 1 (n:21) Patients undergoing DJ stent insertion in one ureter and ureterorenoscopic (URS) lithotripsy for the contralateral ureteral stone. Group 2 (n:91), URS lithotripsy for both ureteral stones and Group 3 (n:41) patients undergoing bilateral DJ stent insertion. The outcomes of the procedures and the relevant patient as well as stone related factors have been comparatively evaluated in three groups. RESULTS: While associated UTI rates and serum creatinine levels were significantly higher in bilateral DJ group, previous URS history was found to be significantly higher in cases undergoing bilateral URS than those undergoing bilateral DJ stenting. URS was performed significantly more often in cases with lower ureteral stones and DJ stenting seems to be more rational approach in upper ureteral stones. In patients with lower ureteral stones, larger and harder stones, endourologists tended to perform URS as the first option. CONCLUSIONS: Decision making for a rational approach in cases with bilateral ureteral stones my be challenging. Our findings demonstated that serum creatinine levels, associated UTI, location and the hardness of the stone and previous ureteroscopy anamnesis could be important factors in making a decision between JJ stenting and ureteroscopic stone extraction in emergency conditions.

Predictive role of ureteral wall thickness and patient characteristics in endoscopic treatment outcomes for ureteral stricture disease following stone surgery.

PURPOSE: To evaluate the role of certain radiological parameters and patient characteristics in predicting the success of endoscopic treatment in ureteral stricture disease. METHODS: Fifty one adult patients with ureteral stricture disease (< 1 cm) after developing due to upper ureteral stones with ureteroscopic laser disintegration were included and in addition to stone and patient parameters, radiological parameters including ureteral wall thickness (UWT) at the impacted stone site were also measured on computed tomography (CT) images. Patients were divided into two groups: Group 1: Patients with endoscopic treatment success and Group 2: Patients with endoscopic treatment failure. The possible relationship between the UWT values and other radiological parameter was comparatively evaluated. RESULTS: Mean UWT value assessed at the treated stone site was significantly higher in cases unresponsive to endoscopic treatment with values of 2.77 ± 1.03 mm and 4.25 ± 1.32 mm in Group 1 and 2 respectively. A cut off value 3.55 mm for UWT was found to be highly predictive for endoscopic treatment failure. CONCLUSIONS: Our current results indicated that assessment of UWT value at the obstructing stone could be helpful enough to predict the likelihood of failure following endoscopic management of strictures with high sensitivity and specificity. Evaluation of this particular parameter could let the endourologists to look for more rational treatment alternatives with necessary measures taken on time.

Ureteral stricture formation after endoscopic removal of obstructing stones: could it be predicted with well-assessed radiological parameters?

The possible role of well-assessed radiological parameters in the prediction of ureteral stricture formation in cases with impacted obstructive ureteral calculi has been evaluated. 46 adult patients with or without ureteral stricture formation after ureteroscopic stone management were included. In addition to stone size and some certain radiological parameters including ureteral wall thickness (UWT) of the involved ureter at the impacted stone site was also measured and noted on computed tomography (CT) images. Parameters were evaluated in two subgroups of cases, namely: Group 1: patients in whom a ureteral stricture formed after endoscopic stone removal and Group 2: patients normal ureteral anatomy without any stricture formation. The possible relationship between the UWT values and degree of hydronephrosis (HN) with subsequent stricture formation was comparatively evaluated. All of the stones were proximal ureteral calculi in both groups. Both the degree of HN and proximal ureteral diameter (PUD) parenchymal was higher in cases with stricture formation. In addition, mean parenchymal thickness was lower and mean values of UWT measurements at the stone site were 3.70 ± 0.97 mm and 2.17 ± 0.26 mm in Groups 1 and 2, respectively. A cutoff value 2.49 mm for UWT was found to be highly predictive for stricture formation. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of ureteral stricture formation with high sensitivity and specificity . This evaluation along with some other radiological parameters may enable the urologists to follow such cases on this aspect with necessary measures taken.

Desires and attitudes of outpatients and physicians regarding the use of teleurology during the pandemic: a prospective survey study.

OBJECTIVE: It is not known to date how many patients admitted to urology outpatient clinics are willing to use telemedicine. We aimed to investigate knowledge levels and attitudes concerning the utilization of teleurology by patients applying to urology outpatient clinics. METHODS: This prospective multicentre survey study included 334 patients aged 18-65 years who applied to an urology outpatient clinics. The patients were asked questions about their attitudes and expectations regarding teleurology. Diseases were divided into seven subgroups due to the broad spectrum of diagnoses. Physicians' and patients' opinions on whether it was possible to manage the current medical condition via teleurology were recorded. RESULTS: 69.5% of patients stated that they had sufficient technical skills to use teleurology by themselves for medical examination. 55.4% of patients and 78.4% of physicians responded that the existing complaints were suitable for teleurology. Both patients and physicians deemed genital system diseases and urinary tract infections suitable for teleurology (p<0.001, p<0.001 for physicians, and p<0.001, p<0.001 for patients), whereas urine transport, storage and emptying disorders (p=0.003) and benign prostatic hyperplasia (p=0.029) were deemed to be suitable for teleurology only by the physicians. CONCLUSION: Our study shows that (i) the majority of our patient population has a telecommunications infrastructure suitable for teleurology, (ii) teleurology has aroused interest among patients, particularly during the pandemic period, and (iii) physicians and patients have high expectations that the problem can be solved with teleurology in suitable patients.