Urinary tract injuries during treatment of patients with morbidly adherent placenta.

INTRODUCTION: Urinary tract injuries (UTI) are a frequent complication of morbidly adherent placenta (MAP) management. In this study, we aim to characterize the type of UTI that occurs and to define if their incidence varies after establishing a fixed interdisciplinary group for the protocolized management of patients with MAP. METHODOLOGY: All patients with confirmed MAP attended between 2011 and 2019 in our institution, were included. We analyzed the effect of a change in the surgical protocol including rigid ureteral catheters, vesicouterine dissection before hysterotomy and interdisciplinary planning, in the bladder or ureteral injuries incidence. RESULTS: The study included 65 women. UTI was identified in 27.7% of patients and was associated with a greater volume of blood loss, transfusion requirement, hospital stay, and the need for additional surgeries. There was a high frequency of UTI in patients without protocolized management. The use of rigid ureteral catheters and retrovesical dissection before hysterotomy were associated with a less ureteral injury. CONCLUSIONS: Developing expertise among the members of the surgical team is essential to improve results. Using rigid ureteral catheters, performing retrovesical dissection before hysterotomy, and performing less extensive surgeries in selected patients are associated with a low frequency of ureteral injuries.

Natural Orifice Transluminal Endoscopic Surgery for Correction of Vesicovaginal Fistulas after Hysterectomy Due to Morbidly Adherent Placenta.

BACKGROUND: Vesicovaginal fistula (VVF) is a difficult-to-treat complication of obstetric hysterectomy. There are multiple management options, with a preference for surgical repair via abdominal or vaginal approach. We describe a transurethral natural orifice transluminal endoscopic surgery (NOTES) using barbed suture, in 3 cases of VVF after hysterectomy due to morbidly adherent placenta (MAP). CASES: Three patients with VVFs after hysterectomy due to MAP underwent a transurethral endoscopic suture repair. Two patients had complete resolution of the fistula, and the third required additional repair by laparotomy; however, a decrease was observed in the size of the VVF after the initial endoscopic repair. CONCLUSION: The transurethral NOTES approach for VVF after MAP hysterectomy is a minimally invasive procedure that is valid as an initial approach for this type of complication.

Nefrectomía laparoscópica versus nefrectomía abierta. Experiencia en la Fundación Valle del Lili / Comparison between laparoscopic and nephrectomy at a colombia hospital

Objetivo: Comparar los resultados clínicos entre nefrectomía laparoscópica versus nefrectomía abierta en un hospital de Colombia. Métodos: Diseño: Cohorte retrospectiva. Lugar: Servicio de urología, Fundación Valle del Lili. Se incluyeron todos los pacientes que fueron llevados a nefrectomía laparoscópica o abierta entre 1995-2005. Se recolecto la información demográfica y clínica del procedimiento, hasta el egreso hospitalario. Los datos se analizaron en STATA v.8.0Resultados: Se incluyeron 143 pacientes. De ellos, 54 fueron tratados laparoscópicamente (laparoscopia total en 40, mano-asistida en 14) y con nefrectomía abierta en 89. El total de riñones extraídos fue de 161; 64 de ellos por laparoscopia. Los pacientes llevados a laparoscopia fueron más jóvenes (36 y 22 vs 48,5 y 19 años, p<0,05), pero con mucha más morbilidad (insuficiencia renal crónica). Hubo cuatro conversiones en los pacientes llevados a laparoscopia, todas por dificultades técnicas: una por salida de material purulento abundante, una por tumor de gran tamaño, y dos por adherencias...