The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy.

OBJECTIVE: To evaluate the incidence of urinary tract injury due to hysterectomy for benign disease. STUDY DESIGN: Patients were enrolled prospectively from 3 sites. All patients undergoing abdominal, vaginal, or laparoscopic hysterectomy for benign disease underwent diagnostic cystourethroscopy. RESULTS: Four hundred seventy-one patients participated. Ninety-six percent (24/25) of urinary tract injuries were detected intraoperatively. There were 8 cases of ureteral injury (1.7%) and 17 cases of bladder injury (3.6%). Ureteral injury was associated with concurrent prolapse surgery (7.3% vs 1.2%; P = .025). Bladder injury was associated with concurrent anti-incontinence procedures (12.5% vs 3.1%; P = .049). Abdominal hysterectomy was associated with a higher incidence of ureteral injury (2.2% vs 1.2%) but this was not significant. Only 12.5% of ureteral injuries and 35.3% of bladder injuries were detected before cystoscopy. CONCLUSION: The incidence of urinary tract injury during hysterectomy is 4.8%. Surgery for prolapse or incontinence increases the risk. Routine use of cystoscopy during hysterectomy should be considered.

Laparoscopic pomeroy tubal ligation: a comparison with tubal cauterization in a teaching hospital.

OBJECTIVE: To compare laparoscopic Pomeroy tubal ligation to standard bipolar tubal cauterization for the outcome measures of failure rate, complication rate and procedure duration, with an analysis of the effect of resident experience on procedure duration. STUDY DESIGN: Retrospective study of patients presenting for interval sterilization between August 1998 and June 2000. RESULTS: The characteristics of the laparoscopic Pomeroy (n = 99) and bipolar cautery (n = 62) patients were comparable. The mean procedure duration was 40.8 +/- 14.6 minutes for laparoscopic Pomeroy and 39.6 +/- 18.8 minutes for bipolar cautery (p < 0.68). Multiple regression analysis revealed that procedure duration was a function of both months in residency (R2 = .098, p < 0.007) and number of laparoscopic Pomeroy procedures performed (R2 = .082, p < 0.01). One complication occurred with each procedure (p < 0.576). Two sterilization failures occurred after bipolar cautery and 1 after laparoscopic Pomeroy (p < 0.33). The laparoscopic Pomeroy failure occurred in the shortest tubal segment obtained, 0.7 cm, versus the average segment length, 2.07 +/- .79 cm. CONCLUSION: Laparoscopic Pomeroy did not differ from bipolar cautery for the outcome measures studied. Both time in residency and procedure-specific experience affect the duration of laparoscopic Pomeroy. A tubal segment length of 1 cm should be removed to limit sterilization failures.

A função do debriefing psicológico no tratamento de vítimas de trauma / The role of psychological debriefing in the treatment of victims of trauma

A aplicaçäo do chamado debriefing psicológico (DP) tornou-se uma intervençäo disseminada e esperada após a exposiçäo ao trauma. Este artigo avalia a validade desse enfoque e relata o consenso entre os especialistas em relaçäo ao seu uso. Revisöes sistemáticas e narrativas säo resumidas e as áreas de acordo e desacordo säo delineadas. Em resumo, conclui-se que a maioria das pessoas näo fica traumatizada devido a eventos estressantes; que o DP parece ter pequeno impacto; que uma forma de DP chamada de "debriefing sobre o incidente crítico (DICE)" pode exercer efeitos nocivos em certos indivíduos e que aqueles com efeitos mais negativos devido ao DP parecem ser os que mais sofreram com o trauma inicial. Näo há ensaios clínicos randomizados que sustentem a validade do DP em grupo. A intervençäo precoce Cognitivo-Comportamental parece ser o enfoque mais promissor em pacientes com apresentaçöes clínicas bem definidas. É oferecido um conjunto genérico de diretrizes para a intervençäo pós-trauma