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1.
Pan Afr Med J ; 30: 145, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30374391

RESUMO

Iatrogenic ureteral lesions may occur after any pelvic surgery. They are severe and can affect renal function and even vital prognosis. This study aimed to determine the clinical aspects and the therapeutic approaches of this injury. We conducted a retrospective study of six patients with iatrogenic ureteral lesions following gynecologic or obstetric surgery whose data were collected in the Department of Urology in Kairouan on a period of 4 years (2012-2016). The average age of our patients was 46 years. They were all multiparous. Clinical symptoms were variable depending on the type of lesion. Intravenous urography is very useful for diagnosis. It was performed in 4 cases showing abnormalities. Treatment was based on the insertion of a catheter in one case and on 5 uretero-vesical reimplantations. The postoperative course was marked by a nephrectomy. Iatrogenic ureteral lesions have become a rarity. They are correlated with the degree of medicalization in the country. Gynecological and obstetric surgery is the main cause of iatrogenic ureteral lesions. Prognosis is conditioned by early diagnosis and the anatomic condition of the ureter.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ureter/lesões , Doenças Ureterais/etiologia , Adulto , Diagnóstico Precoce , Feminino , Humanos , Pessoa de Meia-Idade , Nefrectomia/métodos , Complicações Pós-Operatórias/diagnóstico , Prognóstico , Estudos Retrospectivos , Tunísia , Doenças Ureterais/diagnóstico , Doenças Ureterais/epidemiologia
2.
BMC Urol ; 18(1): 70, 2018 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-30134978

RESUMO

BACKGROUND: Uretero-fallopian fistula (UFF) is a very rare surgery complication which usually happens after surgeries of fallopian tube or ureter. There has been no report of interventional operations of fallopian tube causing UFF. CASE PRESENTATION: A 41-year-old female received fallopian tube embolization for birth control. After that she noticed "clear vaginal discharge". She neglected that symptom for 7 years, until a sudden onset of abdominal pain brought her to the ER. Retrograde ureterogram confirmed UFF and revealed severe hydronephrosis of the left kidney. She received left nephrectomy afterwards and recovered well, with no urine leakage from her vagina. CONCLUSION: UFF could be caused by interventional operations of fallopian tube, and could lead to severe consequences. The application of fallopian tube embolization should be carefully controlled.


Assuntos
Embolização Terapêutica/efeitos adversos , Doenças das Tubas Uterinas/etiologia , Tubas Uterinas , Histeroscopia/efeitos adversos , Esterilização Reprodutiva/efeitos adversos , Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Adulto , Doenças das Tubas Uterinas/diagnóstico , Feminino , Fístula/diagnóstico , Fístula/etiologia , Humanos , Doenças Ureterais/diagnóstico , Fístula Urinária/diagnóstico
3.
Clin Nephrol ; 89(4): 229-240, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29493505

RESUMO

There are substantial doubts pertaining to the clinical usefulness of radiological and surgical interventions in the management of renovascular disease, particularly in patients with diffuse atherosclerotic vascular disease. This article reviews the current knowledge on advantages and limitations of interventional techniques in the management of patients with atherosclerotic renovascular disease.
.


Assuntos
Obstrução da Artéria Renal/complicações , Doenças Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Humanos , Obstrução da Artéria Renal/cirurgia , Doenças Ureterais/etiologia
4.
Taiwan J Obstet Gynecol ; 57(1): 150-152, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29458888

RESUMO

OBJECTIVE: To know the diagnostic tools and proper management of ureterovaginal fistula following neglected vaginal foreign body in order to achieve optimal outcome. CASE REPORT: A case of ureterovaginal fistula associated with a neglected vaginal foreign body. The patient was complaining of a foul-smelling vaginal discharge and lower abdominal pain. On vaginal examination, a hard and large foreign body was found. Examination under anesthesia was performed, and an aerosol cap was removed from her vagina. The patient developed urinary incontinence after removal of the foreign body. Subsequent work-up demonstrated the presence of a right ureterovaginal fistula. The patient underwent an abdominal ureteroneocystostomy. At one year follow up, the patient had fully recovered. CONCLUSION: Ureterovaginal fistula following neglected vaginal foreign body is a serious condition. Early diagnosis, treatment of infection and proper surgical management can improve the outcome and decrease complications.


Assuntos
Corpos Estranhos/complicações , Doenças Ureterais/complicações , Fístula Urinária/complicações , Fístula Vaginal/complicações , Adulto , Feminino , Corpos Estranhos/cirurgia , Humanos , Ureter/patologia , Ureter/cirurgia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Incontinência Urinária/etiologia , Vagina , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgia
5.
Vasc Endovascular Surg ; 52(4): 275-286, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29482486

RESUMO

BACKGROUND: Ureteroarterial fistula (UAF) represents an uncommon complication after urological surgery; however, this is a well-documented condition in patients with predisposing risk factors. The aim of the present study is to report and analyze the endovascular management of a series of patients with UAF, treated in authors' hospital, and to report and analyze the same data concerning patients retrieved from a systematic literature review. METHODS: Authors conducted a retrospective analysis of prospectively collected data and a systematic literature review. The research was carried out through PubMed database searching the following keywords: "uretero arterial fistula" and "uretero iliac fistula." It includes only articles reporting the endovascular management. RESULTS: Forty-six articles were included in the present study for a total of 94 patients. Risk factors were as follows: chronic indwelling ureteral stents, pelvic surgery, radiotherapy, iliac artery pseudo-aneurysm, and chemotherapy. All patients had gross hematuria at presentation. Stent graft placement was performed in 89 patients, embolization in 5 patients, and iliac internal artery embolization combined with stent graft placement was performed in 24 patients. Four postprocedural complications were observed (4.2%). During a median follow-up of 8 months, 10 complications related to UAF were observed (10.6%): rebleeding (7 cases) and stent thrombosis (3 cases). Two patients died for causes related to UAF (2.1%): rebleeding (1) and retroperitoneal abscess (1). CONCLUSION: Based on the present data, endovascular treatment is feasible and safe with low postprocedural complications and mortality rate. Considering the increase in surgery and radiotherapy performed, UAF should be always debated in patients with massive hematuria.


Assuntos
Implante de Prótese Vascular , Embolização Terapêutica , Procedimentos Endovasculares , Doenças Ureterais/terapia , Fístula Urinária/terapia , Fístula Vascular/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Stents , Resultado do Tratamento , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/etiologia , Doenças Ureterais/mortalidade , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/etiologia , Fístula Urinária/mortalidade , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/mortalidade
6.
Urol J ; 15(2): 58-60, 2018 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-29290085

RESUMO

Soft tissue calcification is common in uremic patients. Wound calcification or ossification is not so prevalent except in specific conditions like inflammation and ischemia or wound tension. We present a 40-year-old transplanted patient, not only perirenal ossification but also with multiple perirenal stones. The presentation was severe pain on the site of transplantation. Pre-op CT scan revealed perirenal calcified mass. Intraoperative finding was verythick tissue accompanied with a lot of stones around the transplanted kidney. The patient had history of ureteral fistula after renal transplantation that needed temporary percutaneous nephrostomy and then uretero-neocystomy.It seems that urinary leakage through nephrostomy site probably is the predisposing factor for stone formation around the kidney where as there is no stone inside the Kidney.


Assuntos
Calcinose/etiologia , Nefrostomia Percutânea/efeitos adversos , Ossificação Heterotópica/etiologia , Complicações Pós-Operatórias/etiologia , Doenças Ureterais/cirurgia , Fístula Urinária/cirurgia , Adulto , Humanos , Cálculos Renais/etiologia , Transplante de Rim/efeitos adversos , Masculino , Pelve , Doenças Ureterais/etiologia , Fístula Urinária/etiologia
7.
Dis Colon Rectum ; 61(1): 84-88, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29215477

RESUMO

BACKGROUND: Despite improvement in technique and technology, using prophylactic ureteral catheters to avoid iatrogenic ureteral injury during colectomy remains controversial. OBJECTIVE: The aim of this study was to evaluate outcomes and costs attributable to prophylactic ureteral catheters with colectomy. DESIGN: This was a retrospective study. SETTINGS: The study was conducted at a single tertiary care center. PATIENTS: The colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2014 was queried. MAIN OUTCOME MEASURES: The primary end point was the rate of 30-day ureteral injury after colectomy. Univariate and multivariate analyses determined factors associated with ureteral injury and urinary tract infection in patients undergoing colectomy. RESULTS: A total of 51,125 patients were identified with a mean age of 60.9 ± 14.9 years and a BMI of 28.4 ± 6.7 k/m; 4.90% (n = 2486) of colectomies were performed with prophylactic catheters, and 333 ureteral injuries (0.65%) were identified. Prophylactic ureteral catheters were most commonly used for diverticular disease (42.2%; n = 1048), with injury occurring most often during colectomy for diverticular disease (36.0%; n = 120). Univariate analysis of outcomes demonstrated higher rates of ileus, wound infection, urinary tract infection, urinary tract infection as reason for readmission, superficial site infection, and 30-day readmission in patients with prophylactic ureteral catheter placement. On multivariate analysis, prophylactic ureteral catheter placement was associated with a lower rate of ureteral injury (OR = 0.45 (95% CI, 0.25-0.81)). LIMITATIONS: This was a retrospective study using a clinical data set. CONCLUSIONS: Here, prophylactic ureteral catheters were used in 4.9% of colectomies and most commonly for diverticulitis. On multivariate analysis, prophylactic catheter placement was associated with a lower rate of ureteral injury. Additional research is needed to delineate patient populations most likely to benefit from prophylactic ureteral stent placement. See Video Abstract at http://links.lww.com/DCR/A482.


Assuntos
Colectomia/efeitos adversos , Doenças do Colo/cirurgia , Ureter/lesões , Doenças Ureterais/prevenção & controle , Cateteres Urinários , Idoso , Humanos , Doença Iatrogênica/prevenção & controle , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Estudos Retrospectivos , Doenças Ureterais/etiologia
8.
Anat Sci Int ; 93(3): 394-399, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29222673

RESUMO

A unilateral megaureter was found in an elderly female cadaver during routine dissection. The left proximal ureter, which was thick and convolute, descended and entered into the pelvic cavity, where the distal ureter was attached to the posterior pelvic wall at the inlet level. Removal of connective tissue surrounding the attached region revealed ureteric entrapment in the sacroiliac joint. The ipsilateral kidney, from which the megaureter originated, showed no pelvicalyceal dilatation. In contrast, the left kidney was enlarged, weighing 24% more than the right kidney. Differences in the upper urinary system between the obstructed and normal sides were examined in terms of gross anatomy, measurements, and histology. Although ureteric obstruction frequently causes hydroureter and hydronephrosis, the present case is very rare as the incomplete obstruction may have stimulated ipsilateral kidney growth, instead of contralateral compensatory augmentation.


Assuntos
Rim/patologia , Articulação Sacroilíaca/patologia , Ureter/patologia , Doenças Ureterais/etiologia , Obstrução Ureteral/complicações , Obstrução Ureteral/patologia , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Hipertrofia/etiologia
9.
Medicine (Baltimore) ; 96(49): e8807, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29245241

RESUMO

RATIONALE: Both inflammatory myofibroblastic tumor (IMT) and retroperitoneal fibrosis are rare lesions, but kidney involvement is more rare. It is the first study about IMT of the kidney in a patient with perinephric and periureteric fibrosis and we hold that fibroblast proliferation may be an intermediate status in oncogenesis of IMT. But further investigation is necessary in order to better clarify the relationship between fibroblast proliferation and IMT. PATIENT CONCERNS: A 54-year-old female presented no positive signs except dull back pain after overwork. DIAGNOSES: On the basis of the urinary ultrasonography and computed tomography (CT) scan, we strongly suspected a renal cell carcinoma. INTERVENTIONS: Considering the little remaining function of the right kidney and the possibility of malignancy, we performed a laparoscopic right radical nephrectomy. OUTCOMES: According to the analysis of the postoperative paraffin section and immunohistochemistry assay, a final diagnosis of IMT and retroperitoneal fibrosis nodules was made. LESSONS: Both IMTs are rare lesions and its etiology and pathogeny are unclear. It is the first study about IMT of the kidney in a patient with perinephric and periureteric fibrosis. This report suggested that fibroblast proliferation may be an intermediate status in oncogenesis of IMT, but further investigation is necessary in order to better clarify the relationship between fibroblast proliferation and IMT. The preoperative diagnosis of renal IMT remains difficult. Preoperative fine-needle aspiration or percutaneous biopsy and intraoperative frozen section were applied to confirm the diagnosis to avoid unnecessary nephrectomy, especially in patients with renal insufficiency, bilateral masses, or a solitary kidney.


Assuntos
Neoplasias Renais/complicações , Neoplasias de Tecido Muscular/complicações , Perinefrite/etiologia , Doenças Ureterais/etiologia , Feminino , Fibrose , Humanos , Neoplasias Renais/cirurgia , Pessoa de Meia-Idade , Neoplasias de Tecido Muscular/cirurgia , Nefrectomia/métodos , Perinefrite/cirurgia , Doenças Ureterais/cirurgia
10.
Rev Med Inst Mex Seguro Soc ; 55(5): 568-574, 2017 Sep-Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-29193937

RESUMO

BACKGROUND: The aim of this paper is to compare the efficacy of tamsulosin, oxybutynin or their combination for the treatment of symptoms related to double J stent (DJS). METHODS: Randomized clinical non-blinded trial with three arms (tamsulosin, oxybutynin or combination) to assess the improvement of ureteral related symptoms with DJS with the questionnaire of Ureteral Stent Symptom Questionnaire (USSQ) and the adverse effects of treatment. Evaluations were made at 7 and 21 days after the placement of DJS. The maneuvers were compared using Chi squared test, Kruskall-Wallis, ANOVA and Wilcoxon considering a statistically significant p ≤ 0.05. RESULTS: 170 patients with CJJ were evaluated. A perprotocol analysis was performed in 142 patients, 53 received tamsulosin (37.4%), 42 oxybutynin (29.6%) and 47 the combination of both (33%). At 7 and 21 days the improvement was similar in all three arms. Men with tamsulosin and women with oxybutynin had less general symptoms. CONCLUSIONS: Tamsulosin, oxybutynin or its combination similarly improve ureteral stent related symptoms and this improvement becomes more noticeable over time. Men are less symptomatic with tamsulosin and women with oxybutynin.


Assuntos
Ácidos Mandélicos/uso terapêutico , Sulfonamidas/uso terapêutico , Doenças Ureterais/tratamento farmacológico , Cateteres Urinários/efeitos adversos , Agentes Urológicos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tansulosina , Resultado do Tratamento , Doenças Ureterais/etiologia
11.
Urologia ; 84(4): 240-243, 2017 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-28967060

RESUMO

INTRODUCTION: The use of a pessary to treat a pelvic organ prolapse (POP) is a valid non-invasive option. Severe complications are usually associated with neglected, oversized, or misplaced pessaries. Major complications include fistulas, bowel or bladder erosion, and hydroureteronephrosis (HUN). MATERIALS AND METHODS: We reviewed the literature and our experience in the management of HUN in the last decade, as a consequence of pessary placement. RESULTS: We used flow charts to take an accurate medical history of each patient. Blood and urine analyses were taken at admission to assess the potential presence of sepsis, renal failure, and urinary tract infection. Physical examination included vaginal examination. In cases of pessary presence with a concomitant increase of serum creatinine value, a possible ureteral obstruction is suspected. In order to assess the presence of HUN and its underlying causes, a computed tomography (CT) scan should be performed to assess the mechanism of urinary tract obstruction. However, in case of renal insufficiency, abdominal ultrasonography (US) could be sufficient. If HUN is detected in a patient with no signs of urosepsis, we suggest a conservative management by the removal of the pessary and catheter placement. When urosepsis is suspected, it is mandatory to administer antibiotic therapy and evaluate the HUN drainage by nephrostomy. CONCLUSIONS: There is no uniform management of women with HUN and a concomitant pessary. For this reason, and based on the literature and our experience, we propose an original management flowchart.


Assuntos
Hidronefrose/etiologia , Hidronefrose/terapia , Pessários/efeitos adversos , Desenho de Programas de Computador , Doenças Ureterais/etiologia , Doenças Ureterais/terapia , Feminino , Humanos
13.
Radiol Med ; 122(9): 696-704, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28510805

RESUMO

Iatrogenic ureteral injuries are a dramatic complication in medical practice. Nowadays there are no universal guidelines for their management. The aim of our study was to evaluate the feasibility of the percutaneous treatment in restoring ureteral integrity in 19 patients that came to our attention. In each case retrograde stenting failed and patients were candidates for re-surgery. Our strategy consists of two phases. The first step is the nephrostomy that allows an external urinary diversion putting dry the damaged ureteral segment. The second step is the anterograde ureteral double-J stenting that keeps near the two stumps promoting the healing of the injured tract. In complete sections, when both retrograde and anterograde stenting singularly failed, we performed a rendez-vous technique with a combined radiological trans-nephrostomic access and urological cystoscopic approach to realign and catheterize the ureteral stumps. In patients with Bricker urinary diversion, peri-anastomotic leaks were treated by positioning a multi-hole pig-tail catheter with the inner end in the renal pelvis and the distal portion outgoing from the cutaneous stoma. Subsequent pyelographic controls demonstrated the resolution of the ureteral leak in all patients and none required a surgical re-intervention. Nephrostomies were removed and ureteral stents were regularly changed. We conclude that interventional uro-radiology may offer a valid conservative option in iatrogenic urinary injuries.


Assuntos
Doença Iatrogênica , Radiografia Intervencionista , Ureter/lesões , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Cistoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Reoperação , Stents , Resultado do Tratamento
14.
Ann Vasc Surg ; 44: 459-465, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28495539

RESUMO

BACKGROUND: Ureteroarterial fistulas (UAFs) have a low incidence but are a potentially fatal cause of hematuria. Initially treated by open surgery, endovascular techniques have decreased potential complications. MATERIAL AND METHODS: We present a short series of UAFs (n = 5) treated in our institution in the last 10 years: 1 case showed up after aorta-iliac bypass surgery, 1 case after endovascular aortic repair and embolization of right hypogastric artery, and 3 cases after oncological surgeries. We review the published literature via PubMed. RESULTS: The different approaches (2 open and 3 endovascular procedures) were based on the clinical situation of the patients and on technical limitations. Three patients died after the procedure (2 after open surgery and 1 after endovascular treatment). In our institution, endovascular treatment showed good results in terms of early complications and associated mortality compared with open surgery. CONCLUSIONS: UAF is a rare but a potentially fatal complication in patients with predisposing factors. No long-term follow-up has been published to assess the possible complications arising from the technique, such as prosthetic infection. No antibiotic treatment protocols have been established, so long-term follow-up is necessary to determine late complications.


Assuntos
Procedimentos Endovasculares , Doenças Ureterais/cirurgia , Fístula Urinária/cirurgia , Fístula Vascular/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Angiografia por Tomografia Computadorizada , Evolução Fatal , Feminino , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do Tratamento , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/etiologia , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/etiologia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia
15.
Minerva Urol Nefrol ; 69(6): 613-618, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28494578

RESUMO

BACKGROUND: Ureteral strictures occur in approximately 3-8% of kidney transplant (KTx) recipients. They are usually a late event which needs surgical re-intervention with a subsequent increased risk of graft loss. This retrospective study presents a single-centre experience in managing ureteral complications using firstly a minimally invasive approach. METHODS: Between January 2000 and November 2012, 838 patients underwent KTx with Lich-Gregoire uretero-vesical anastomosis. Ureteral complications consisting in 6 fistulas and 18 strictures were observed in 24 grafts, with an overall incidence of 2.6%. The retrograde placement of a double J stent was attempted first in 16 grafts and succeeded in 12 (75%); the remaining 4 cases underwent open repair with anastomosis to the native ureter. Antegrade/combined ureteral stenting via a percutaneous nephrostomy was attempted in 8 grafts and succeeded in 4 (50%); the remaining 4 (2 fistulas and 2 strictures) underwent open repair with anastomosis to the native ureter. RESULTS: After an average period of 8.36 months (range 1-36) the double J stents were removed and the ureters were unobstructed in 11 (45.8%), while open surgical treatment was necessary in the remaining 5. Repeated cystoscopic stent changes were successfully performed in 13 patients. Early onset ureteral stenoses were found in 10 out of 19 patients and successfully treated by a mini-invasive approach in 50% of the cases. Three renal grafts were lost, but this was not due to ureteral complications. CONCLUSIONS: Minimally invasive procedures are recommended in early complications, although open reconstructive surgery maintains a role in late severe obstructions after KTx.


Assuntos
Transplante de Rim/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/cirurgia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Humanos , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/métodos
16.
Vascular ; 25(5): 557-560, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28436317

RESUMO

Background Ureteral arterial fistulas are rare but potentially life threatening. We present a female who developed a ureteral arterial fistula following a right robotic nephrectomy. After several endovascular interventions to control the bleeding had failed, we approached the fistula through the right ureteral stump with coil embolization. Methods Coil embolization of the right ureteral stump was performed. We utilized a 6Fr × 45 cm sheath inserted through one of the cystoscope channels to cannulate the right ureteral orifice. We then performed a retrograde ureterogram. After, we were able to visualize full length of the ureter, ahd we began placing several 10-12 mm Nester coils to pack the ureter and tamponade the fistula for hemostasis. After the ureter was packed, we injected 1 g of Vancomycin into the ureter. The sheath and cytoscope were removed and the patient did well and was sent to the recovery room. Results Postoperatively, the patient had no complaints of hematuria and her hemoglobin level remained unchanged. She was observed for a few days prior to being discharged to home. The patient's follow-up at six months revealed resolution of her hematuria. Conclusion Ureteral arterial fistula is a potentially life-threatening condition. Endovascular stenting has provided a safe, reliable alternative to open surgery. However, when endovascular options are not satisfactory, coil embolization of the ureteral stump may serve as a safe and effective alternative treatment for these cases.


Assuntos
Embolização Terapêutica , Artéria Ilíaca , Doenças Ureterais/terapia , Fístula Urinária/terapia , Fístula Vascular/terapia , Adulto , Angiografia por Tomografia Computadorizada , Cistoscopia , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Nefrectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/etiologia , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/etiologia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia
17.
J Obstet Gynaecol ; 37(5): 639-644, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28325119

RESUMO

Endometriosis can affect up to 10% of women of reproductive age, in a wide range of clinical presentations that vary from mild to severe or deep endometriosis. Deep endometriosis can affect the urinary tract in 1-5% to 15-25% cases. Even though deep endometriosis' surgeries are usually complex with higher rate of complications, conservative management is not always considered as an option because of its high failure rates. This paper describes two cases of deep endometriosis with ureteric involvement (hydronephrosis) treated conservatively with a double-pigtail stent plus a Levonorgestrel intrauterine device, after conservative surgery, who remained symptom free with no evidence of recurrence at 3 years follow-up, avoiding radical high-risk surgery. Impact statement Several treatments have been described for endometriosis. From a symptomatic perspective, conservative medical management has been proposed with a variable response. Concerning deep endometriosis (affecting the urinary or digestive tract), the definitive treatment has always been thought to be radical surgery. However, this can lead to several complications. To illustrate a possible more conservative approach this paper describes two cases of deep infiltrating endometriosis affecting the ureter, treated conservatively with a temporary pigtail ureter stent plus a Levonorgestrel intrauterine device. The management demonstrates that, in a selected population, conservative treatment solves the urinary disease avoiding the surgical complications and, what is more, improving patients' symptoms in a permanent way. Further prospective studies are needed to confirm whether the introduction of this management in clinical practice would reduce the need for surgery thereby, avoiding high-risk surgery and improving the success rate of conservative management.


Assuntos
Endometriose/terapia , Procedimentos Cirúrgicos em Ginecologia , Hidronefrose/terapia , Dispositivos Intrauterinos Medicados , Doenças Ureterais/terapia , Adulto , Anticoncepcionais Femininos/administração & dosagem , Endometriose/complicações , Feminino , Humanos , Hidronefrose/etiologia , Levanogestrel/administração & dosagem , Pessoa de Meia-Idade , Stents , Doenças Ureterais/etiologia
20.
J Minim Invasive Gynecol ; 24(3): 466-472, 2017 Mar - Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28089810

RESUMO

STUDY OBJECTIVE: To evaluate if laparoscopic treatment of ureteral endometriosis is feasible, safe, and effective and to determine if ureteral dilatation and/or the number of incisions increases complications. DESIGN: An institutional review board-approved retrospective cohort study of consecutive patients who underwent surgery for deep infiltrating endometriosis involving the ureter with hydronephrosis (Canadian Task Force classification III). SETTING: A university hospital. PATIENTS: Of 658 patients who had surgery for deep infiltrating endometriosis between November 2004 and December 2013, 198 of the 658 patients had ureteral endometriosis and required ureterolysis, and 28 of the 198 patients were identified with ureteral dilatation and hydronephrosis associated with endometriosis. INTERVENTIONS: Of these 28 cases, 15 ureterolyses, 12 reanastomoses, and 1 reimplantation were performed. MEASUREMENTS AND MAIN RESULTS: Medical, operative, and pathological data on the evolution of pain, urinary complaints, fertility, complications, and recurrences were collected from clinical records. Additionally, telephone interviews were performed for the follow-up of long-term outcomes. All 28 patients had concomitant surgical procedures because of endometriosis elsewhere in the pelvis or abdomen; 12 (42.9%) underwent surgery of the bowel, whereas 5 (17.9%) had bladder surgery. The evolution of pain after surgery showed a positive response (mean dysmenorrhea evaluation measured by the Numeric Pain Rating Scale from 0-10 preoperatively at the short-term follow-up and the long-term follow-up: 7.25-1.73 and 0.25, respectively). Three complications were noted in the group of 28 patients with ureterohydronephrosis; 1 required surgical reintervention. Logistic regression analyses found vaginal incision (odds ratio = 2.08; 95% CI 0.92-4.73), bladder incision (odds ratio = 8.77; 95% CI 3.25-23.63), number of incisions (odds ratio = 2.12; 95% CI 1.29-3.47), and number of previous surgeries (odds ratio = 1.26; 95% CI 0.93-1.71) as independent risk factors for complications in the group of 198 patients. Three patients underwent reoperation in the group of 28 patients: 1 for ureterovaginal fistula, 1 for persistent ureter dilatation and hydronephrosis, and 1 for persistent pain. CONCLUSION: Laparoscopically assisted ureterolyses, ureteral reanastomoses, and ureteral reimplantation are feasible, safe, and effective treatments for ureteral endometriosis. Complete laparoscopic excision is possible with minimal complications, which seem to be associated with the number of incisions. Ureteral endometriosis should be suspected in all cases of deep infiltrating endometriosis.


Assuntos
Endometriose/cirurgia , Hidronefrose/etiologia , Hidronefrose/cirurgia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Adulto , Dismenorreia/etiologia , Endometriose/complicações , Feminino , Fertilidade , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Ureter/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
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