妇科手术中泌尿系统损伤14例临床分析

目的:探讨妇科手术中泌尿系统损伤的主要原因及诊断、处理和预防的方法。方法:对14例妇科手术中泌尿系统损伤的临床资料进行回顾性分析。结果:在6728例妇科手术中,发生泌尿系统损伤14例,发生率为0.18%。其中输尿管损伤10例,膀胱损伤4例,均在术中、术后及时修补。结论:泌尿系统损伤是妇科手术严重的并发症,应及时诊断处理。     

妇科手术泌尿系损伤的诊断与防治

目的泌尿系损伤是妇科手术最常见的并发症之一。本研究探讨妇科手术中泌尿系损伤的诊断与治疗,以便及早诊断,及早治疗,避免肾功能受损。方法对北京大学人民医院2000年1月至2008年7月间妇科手术进行回顾性分析。结果妇科手术共13380例,共发生泌尿系损伤13例（0．09％）。13例中开腹手术9例／8072例,发生率为0．1％,其中恶性肿瘤6例均为输尿管损伤,良性疾病3例均为膀胱后壁损伤;腹腔镜手术4例／4684例,发生率为0．08％,均为妇科良性疾病,其中输尿管损伤1例,膀胱后壁3例。损伤部位包括输尿管骨盆入口处3例,下段5例,入膀胱壁内段1例。膀胱损伤4例,均位于膀胱后壁。2例术中发现,11例术后经测定引流液肌酐水平及影像学检查确诊,12例均经再次手术修补成功,1例放置输尿管支架3个月保守治疗成功。结论妇科手术泌尿系损伤中最常见的是恶性肿瘤手术,其次是腹腔镜手术,大多数患者经及早诊断、及时处理后,预后较好。     

妇科手术中尿路损伤32例分析

本文收集1975年以来妇科手术中发生输尿管、膀胱及尿道损伤32例,分析报道如下: 资料 1975～1985年,我院妇科手术中发生输尿管损伤4例,其中2例术中及时发现,2例术后3～4天确诊。膀胱损伤8例,其中7例术中及时发现,1例术后第5天阴道流液,术后2个月因尿瘘再次入院。余20例均为外院手术中损伤,术后因尿瘘而入院。其中输尿管损伤7例,膀胱损伤10例,尿道损伤3例。32例尿路损伤部位与妇科手术的种类见表1。     

妇科手术并发泌尿系统损伤16例临床分析

目的:探讨妇科手术中泌尿系统损伤的原因及处理.方法:对我院2001年9月至2009年9月间妇科手术中并发泌尿系统损伤的16例患者进行回顾性分析.结果:8年间共行妇科手术15272例,发生泌尿系统损伤16例,发生率0.105%,其中输尿管损伤10例(0.066%),膀胱损伤4例(0.026%),尿道损伤2例(0.013%).术中发现并处理11例,术后处理5例,均预后良好.结论:妇科手术泌尿系统损伤中最常见的是输尿管损伤,术前应充分准备,术中仔细操作,可减少泌尿系统损伤.     

妇科腹腔镜手术泌尿系损伤的临床分析

目的：探讨妇科腹腔镜手术发生泌尿系损伤的相关因素、诊断、治疗方法及预防措施。方法：回顾分析2002年1月至2012年12月北京大学人民医院妇科腹腔镜手术发生泌尿系损伤患者的临床资料。总结分析患者的疾病类型、手术方式、损伤特点、诊疗情况及预后等。结果：妇科腹腔镜手术共4773例,泌尿系损伤发生18例（0.38％）,其中8例发生于腹腔镜恶性肿瘤手术,8例发生于腹腔镜辅助阴式全子宫切除术（LAVH）,2例发生于腹腔镜附件手术。18例泌尿系损伤患者中5例有腹部手术史,有腹部手术史者的泌尿系损伤发生率高于无手术史者（P〈0.05）。18例泌尿系损伤患者中膀胱损伤4例,其中3例位于膀胱后壁,1例位于膀胱三角区;输尿管损伤14例,其中输尿管上段损伤2例,中段损伤10例,下段损伤2例;左侧输尿管损伤2例,右侧12例。术中发现损伤10例,其中4例膀胱损伤和6例输尿管损伤;术后发现8例,均为输尿管损伤,于术后1～10天发现,均经静脉肾盂造影确诊。11例经再次手术修补成功,7例放置输尿管支架6个月（3～12个月）保守治疗成功。结论：腹腔镜下恶性肿瘤手术、LAVH、有腹部手术史患者发生泌尿系损伤机率较高,输尿管损伤多于膀胱损伤。术者需高度警惕,术后严密观察,如发现泌尿道损伤,尽早请泌尿科医师共同决定治疗方法。     

妇科手术泌尿道损伤49例分析

妇科手术泌尿道损伤发生率相差较大 ,膀胱损伤率为0 2 %～ 19 5 % ,输尿管损伤率为 0 5 %～ 30 % [1,2 ] 。目前因难产造成的尿瘘已较少发生 ,而妇科手术所致的尿瘘相对增加。因而减少泌尿道损伤的发生和正确处理泌尿道损伤 ,应引起妇科医生的重视。1　资料与方法1 1　资料来源　 1990年 1月至 2 0 0 1年 8月我院妇科行开腹手术 2 6 2 38例 ,发生泌尿道损伤共 4 9例 ,其中输尿管损伤 2 4例 ,膀胱损伤 2 5例。年龄 2 5～ 6 7岁 ,平均 4 3岁。其中宫颈癌 13例 ,子宫内膜异位症 11例 ,卵巢癌 6例 ,子宫内膜癌 4例 ,子宫肌瘤 9例 ,其他 6例。1…     

妇产科手术泌尿系损伤防治方法的探讨

目的探讨妇产科手术泌尿系统损害的防止及医治。方法选择我院就诊的30例妇产科手术后泌尿系统及器官受到损坏的患者作为研究对象,其中,子宫切除手术15例,剖宫产手术4例,子宫内膜异位症3例,卵巢癌腹膜后打扫术8例。损害器官及部位:输尿管下段13例,膀胱9例,输尿管下段合并膀胱9例。结果输尿管膀胱再植手术13例,膀胱修补术9例,经损害段切除输尿管端端吻合术8例。术后均痊愈。结论妇产科手术是泌尿系器官医源性损害的主要缘由,多致使阴道尿瘘和输尿管等损害。前期输尿管膀胱再植术医治疗效切当。     

妇产科传统手术损伤输尿管膀胱31例临床分析

妇产科手术是最容易引起输尿管下段、膀胱损伤的盆腔手术.医源性输尿管损伤在子宫切除术、根治性子宫切除术、剖宫产术中发生概率约0.5%～1.0%,医源性膀胱损伤导致膀胱阴道瘘也较常见.笔者总结近10年来本院妇产科传统手术导致输尿管、膀胱损伤31例的原因,探讨其预防方法.     

子宫切除术的泌尿道并发症

妇科手术所致的泌尿道并发症比其他手术为多 ,除泌尿道感染外 ,损伤为其重要的并发症。妇科疾病伴发泌尿道感染是比较常见的 ,妇科手术并发的泌尿道感染与术前术后导尿或(和 )安置导尿管有关。本文主要讨论泌尿道的损伤问题。据国外报道 ,75 %的尿瘘是因女性生殖道手术所致 ,其中 1/ 3发生于腹式子宫全切术。最常见损伤部位是膀胱 ,最严重的是输尿管损伤 〔1〕。国内尿瘘发生最多见于难产 ,而妇科手术造成的尿瘘并不多见 ,但随着产科技术的发展 ,目前因难产造成的尿瘘已较少发生 ,而妇科手术所致的尿瘘相对增加。这不能不引起妇科临床的重视…     

膀胱阴道瘘47例手术治疗临床分析

目的探讨妇科手术并发膀胱阴道瘘的病因、治疗及预防措施。方法回顾分析中国人民解放军总医院2000年1月至2009年12月间收治的47例妇科手术、放疗后等并发膀胱阴道瘘患者的临床资料,经美兰试验和膀胱镜检查确诊。妇科手术引起膀胱阴道瘘42例,4例行双侧输尿管经皮造瘘术,43例行修补术,其中25例(58.1%)经膀胱修补,18例(41.9%)经阴道修补。结果本文43例修补术患者中,37例1次修补成功,3例2次修补后成功。术后随访1～6个月无复发。结论妇科子宫切除手术所致膀胱阴道瘘为最多见,术前充分准备及术后严格管理大大提高手术成功率。     

Lesiones del tracto urinario en cirugía ginecológica

We retrospectively analyzed 27 patients with urinary tract injuries who underwent gynecologic surgery from January 1, 2001 to December 31, 2009. The type and timing of injury, diagnostic methods and management of urinary fistulas were evaluated.Twenty-seven urological injuries were incurred during 6,276 gynecologic surgical procedures, representing an incidence of 0.43%. There were 12 urethral injuries and 15 bladder injuries, with an incidence of 0.19% and 0.24%, respectively. Urinary tract injury was diagnosed intraoperatively in 15 patients (55.5%) and postoperatively in 12 (44.5%). Urinary fistulas occurred in nine patients (33%).Most of the urinary tract injuries occurring in gynecologic surgery had optimal results when diagnosed early and managed correctly.     

Urinary tract injury in laparoscopic-assisted vaginal hysterectomy

STUDY OBJECTIVE: To evaluate the incidence and characteristics of urinary tract injury after laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN: A retrospective study that evaluated all cases of urinary tract injury at the time of LAVH in an 11-year period. Parameters including surgical indication, site of injury, time of diagnosis, method of treatment, and long-term follow-up were analyzed. (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. PATIENTS: A total of 38 urinary tract injuries were found in 7725 LAVH. INTERVENTION: LAVH and repair of urinary tract injuries with transvaginal or transabdominal approach. MEASUREMENTS AND MAIN RESULTS: The incidence of urinary tract injury after LAVH was 4.9/1000 procedures: 3.9/1000 for urinary bladder injury and 1.0/1000 for ureteral injury. Prior cesarean section was the most common risk factor for bladder injuries. Ninety-six percent (29/30) of urinary bladder injuries were detected and treated during surgery. Half (4/8, 50%) of the ureteral injuries were identified during surgery. Of the 38 complications, 28 (75.7%) occurred in surgery. CONCLUSION: Most urinary tract injuries in LAVH were identified during surgery and are associated with the surgeon's experience. Bladder injury can be repaired either transvaginally or abdominally; ureteral injury can be repaired abdominally.     

Urinary Tract Injuries in Laparoscopic Hysterectomy: A Systematic Review

The aim of this review was to estimate the incidence of urinary tract injuries associated with laparoscopic hysterectomy and describe the long-term sequelae of these injuries and the impact of early recognition. Studies were identified by searching the PubMed database, spanning the last 10 years. The key words “ureter” or “ureteral” or “urethra” or “urethral” or “bladder” or “urinary tract” and “injury” and “laparoscopy” or “robotic” and “gynecology” were used. Additionally, a separate search was done for “routine cystoscopy” and “gynecology.” The inclusion criteria were published articles of original research referring to urologic injuries occurring during either laparoscopic or robotic surgery for gynecologic indications. Only English language articles from the past 10 years were included. Studies with less than 100 patients and no injuries reported were excluded. No robotic series met these criteria. A primary search of the database yielded 104 articles, and secondary cross-reference yielded 6 articles. After reviewing the abstracts, 40 articles met inclusion criteria and were reviewed in their entirety. Of those 40 articles, 3 were excluded because of an inability to extract urinary tract injuries from total injuries. Statistical analysis was performed using a generalized linear mixed effects model. The overall urinary tract injury rate for laparoscopic hysterectomy was 0.73%. The bladder injury rate ranged from 0.05% to 0.66% across procedure types, and the ureteral injury rate ranged from 0.02% to 0.4% across procedure type. In contrast to earlier publications, which cited unacceptably high urinary tract injury rates, laparoscopic hysterectomy appears to be safe regarding the bladder and ureter.     

Evaluation of Strategies to Prevent Urinary Tract Injury in Minimally Invasive Gynecologic Surgery: A Systematic Review

ObjectiveTo systematically review tools for the prevention of urinary tract injury in adult women undergoing minimally invasive gynecologic surgery.Data SourcesA medical librarian (M.P.H.) searched Ovid Medline 1946 to, Ovid Embase 1929 to, CINAHL 1965 to, Cochrane Library 1974 to, Web of Science 1926 to, and SCOPUS 1974 to present on April 2 and April 3, 2020.Methods of Study SelectionArticles evaluating strategies for the prevention of urinary tract injury at the time of minimally invasive gynecologic surgery were included. Articles that were nongynecologic, nonhuman, and nonadult were excluded. If a study did not describe the surgical approach or type of surgical procedures performed, it was excluded. If the study population was <50% gynecologic or <50% minimally invasive, it was excluded. Articles evaluating techniques for the diagnosis or management of injury, rather than prevention, were excluded.Tabulation, Integration, and ResultsThe search yielded 2344 citations; duplicates were removed, inclusion criteria were applied, and 9 studies remained for analysis. Three studies evaluated bladder catheters, and 6 evaluated ureteral catheters. In the 3 studies evaluating bladder catheters, there were no urinary tract injuries. Urinary tract infection was greater in women who received a bladder catheter. In the studies evaluating the use of ureteral catheters, we found inconsistent reporting and heterogeneity that precluded meta-analysis. The results of the available studies do not indicate that ureteral catheters decrease the risk of injury, and indicate that they increase morbidity.ConclusionThe evidence is insufficient to support the routine use of bladder catheters or ureteral catheters for the prevention of urinary tract injury at the time of minimally invasive gynecologic surgery.     

Disability and litigation from urinary tract injuries at benign gynecologic surgery in Canada

OBJECTIVES: To estimate the prevalence of urinary tract injury and the relative risk of litigation from an injury for benign gynecologic surgery in Canada and to analyze a subset of cases of litigation, determining independent risk factors that predicted medical and legal outcomes. METHODS: The prevalence of urinary tract injury and the relative risks of litigation from an injury were determined from the national hospital discharge abstract and the national physician malpractice databases. Multiple logistic regression was performed on a subset of litigation cases. RESULTS: The prevalence of urinary tract injury at benign gynecologic surgery was low (0.33%). If a patient sustained a urinary tract injury, there was a high relative risk of litigation (relative risk 91, 95% confidence interval [CI] 55-158). Patients had a higher chance of major disability after urinary tract injury from hysterectomy for abnormal uterine bleeding (odds ratio [OR] 6.16, 95% CI 1.13-39.01, P = .04), but a lower chance of this being a permanent disability (OR 0.23, 95% CI 0.05-0.96, P = .05). Permanent disability was more likely after an obstructed ureter compared with other types of urinary tract injuries (OR 4.54, 95% CI 1.55-14.88, P = .008). Only 18% of the injuries were recognized intraoperatively. An acute bladder injury was more likely to be recognized intraoperatively than other types of injury (OR 14.98, 95% CI 3.89-57.74, P < .001). No obstructed ureters or urinary tract fistulae were recognized intraoperatively. CONCLUSION: Urinary tract injuries are an uncommon but significant complication from benign gynecologic surgery. Such injuries are associated a high relative risk of litigation.     

Ureteral assessment after radical hysterectomy

Postoperative intravenous pyelography was performed in 233 patients with stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy between January 1962 and December 1985. Four patients developed symptoms of ureteral injury, two (0.8%) ureteral fistulae, and one (0.4%) stricture and obstruction due to recurrent carcinoma. No ureteral injuries were observed in 229 asymptomatic patients. A 5.2% incidence of transient severe ureteral dilatation occurred in asymptomatic patients, but resolved within a median of 94 days. A significant urinary tract anomaly was observed in 3.4% of preoperative pyelograms. All of these anomalies were apparent at surgery and presented no intraoperative difficulties. Three patients (1.3%) sustained intraoperative ureteral transections, which were diagnosed and repaired without sequelae. In patients with early cervical carcinoma having primary operative treatment, the role of routine preoperative and postoperative intravenous pyelography is questionable.     

Ureteral injury in gynecologic surgery: A ten-year review in a community hospital

Objective: Our purpose was to review and analyze ureteral injuries incidental to gynecologic surgery in a community hospital.Study design: During the study period from Jan. 1, 1983, through Dec. 31, 1992, all patient records in which ureteral injury resulted from gynecologic surgery were reviewed. The operative procedure, pathologic result, location of injury, and type of repair were studied. Additionally, the time of recognition and diagnostic methods in these ureteral injuries were analyzed.Results: Nineteen ureteral injuries were incurred during the performance of 4665 gynecologic surgical procedures, an incidence of 0.4%. Patients ranged in age from 23 to 70 years. Recognition of the ureteral injury occurred intraoperatively in 10 patients and was delayed from 1 to 16 days in 9 patients. Six of the ureteral injuries were repaied by end-to-end anastomosis, 3 by deligation, and 10 by ureteroneocystostomy. Immediate postoperative urinary integrity was found in all patients.Conclusion: Gynecologic surgical procedures in this study resulted in a 0.4% incidence of ureteral injury, and repair of these injuries was successful in all cases for the short term. 1995; 172:1817–1822.)     

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.