Iatrogenic Bladder Perforation Research Articles

Endoscopic sexing in turtles and tortoises: 467 cases (2007-2017).

This multi-institutional retrospective study evaluated the feasibility and safety of endoscopic sex identification in 467 turtles and tortoises, representing 10 species. Medical records of turtles and tortoises that underwent endoscopic sex identification at the University of Georgia, New England Aquarium and Turtle Conservancy were reviewed for presurgical management, anaesthesia, endoscopic equipment and surgical techniques, endoscopic results and complications. The majority of animals weighed less than 200g, were fasted and anaesthetised using an injectable combination of ketamine, dexmedetomidine and morphine or hydromorphone, supplemented by local lidocaine at the prefemoral site. Anaesthetic reversal using atipamezole alone or in combination with naloxone was routine. For uncomplicated procedures, mean total anaesthesia, surgery and recovery times were 22, 4 and 18minutes, respectively. All animals were placed in lateral recumbency for a prefemoral endoscopic approach to the coelom using a rigid telescope and sterile fluid infusion to visualise the gonads. Sex identification was definitive in 99.4% (n=464) of the animals. Iatrogenic bladder perforation was the most common complication (n=5), which necessitated extended anaesthesia and surgical time for repair. Only a single anaesthetic-related death was reported, which was associated with human error and drug overdose. This is the first large-scale study to retrospectively evaluate endoscopic sex identification in multiple chelonian species. Results suggest that endoscopic sexing is a safe, accurate and practical means for sex identification in turtles and tortoises, and represents a valuable tool in their reproductive management.

Bladder perforation during transurethral resection of the bladder: a comprehensive algorithm for diagnosis, management and follow-up

Despite bladder perforation (BP) is a frequent complication during transurethral resection of bladder (TURB) for bladder cancer (BCa), literature lacks systematic reviews focusing on this issue. We aimed to investigate incidence, diagnosis, therapy, and prognosis after BP during TURB for BCa; therapy was distinguished between conservative (without the need for bladder repair) and surgical management (requiring bladder wall closure). A systematic search was conducted up to April 2021 using PubMed, Scopus, Cochrane Database of Systematic Reviews, and Web of Science to identify articles focusing on incidence, detection, management, or survival outcomes after iatrogenic BP. The selection of articles followed the preferred reporting items for systematic review and meta-analyses process. We included 41 studies, involving 21,174 patients. Overall, 521 patients experienced BP during TURB for BCa, with a mean incidence of 2.4%, up to 58.3% when postoperative cystography is routinely performed after all TURB procedures. Risk factors were low body mass index (BMI) (P=0.01), resection depth (P=0.006 and P=0.03), and low surgical experience (P=0.006). Extraperitoneal BP (68.5%) were treated conservatively in 97.5% of patients; intraperitoneal BP were managed with surgical bladder closure in 56% of cases. Overall, three immediate BP-related deaths were recorded due to septic complications. Extravesical tumor seeding was observed after 6 intraperitoneal and 1 extraperitoneal BP (median time: 6.2 months). Intraperitoneal BP (P=0.0003) and bladder closure (P<0.001) were found as independent predictors of extravesical tumor recurrence. BP is more frequent than expected when proper diagnosis is routinely performed after all TURB procedures. Risk factors include low BMI, resection depth, and unexperienced surgeon. The risk of sepsis after BP suggests empirical antibiotic prophylaxis after BP.

Iatrogenic bladder perforation post laparoscopic totally extraperitoneal inguinal hernia repair: Troubleshooting with laparoscopic approach

Iatrogenic bladder perforation post laparoscopic totally extraperitoneal inguinal hernia repair: Troubleshooting with laparoscopic approach

ASSOCIATION OF IATROGENIC GALL BLADDER PERFORATION IN PATIENTS UNDERGOING CHOLECYSTECTOMY.

Background: Laparoscopic cholecystectomy is one of the most commonly performed laparoscopic surgery around the world providing low cost and morbidity treatment for gall bladder diseases. Iatrogenic gallbladder perforation is a common complication of laparaoscopic cholecystectomy .This study was conducted to establish the frequency of iatrogenic gall bladder perforation during laparoscopic cholecystectomy in our patients. Objective: To determine the frequency of iatrogenic gall bladder perforation during laparoscopic cholecystectomy in patients operated in surgical department of Nishtar Hospital Multan. Material and methods; A total of 292 patients undergoing laparoscopic cholecystectomy were recruited in our study. Iatrogenic gallbladder perforation during the surgery was noted in a proforma and data was analyzed by using SPSS version 20. Results; Of these 292 study cases, 87 (40.7%) were male patients and 127 (59.3%) were female patients. Our study results have indicated that majority of our patients i.e. 127 (59.3%) were aged more than 40 years. Iatrogenic gallbladder perforation was present in 40 (18.7%) of our study cases. Conclusion; Laparoscopic cholecystectomy in patients with cholelithiasis is quite safe, reliable and effective procedure as frequency of iatrogenic gallbladder perforation was low in our study cases. However, iatrogenic gallbladder perforation was significantly associated with increasing age, hypertension, and prolonged duration of surgery. Keywords; iatrogenic gallbladder perforation, laparoscopic cholecystectomy, cholelithiasis. DOI : 10.7176/JMPB/54-15 Publication date : April 30 th 2019

Delayed Diagnosis of Iatrogenic Bladder Perforation in a Neonate.

Iatrogenic bladder injuries have been reported in the neonate during umbilical artery/vein catheterization, voiding cystourethrogram, urinary catheterizations, and overwhelming hypoxic conditions. Patients with iatrogenic bladder perforations can present with acute abdomen indicating urinary peritonitis, septic-uremic shock, or subtle symptoms like abdominal distension, pain, hematuria, uremia, electrolyte imbalances, and/or difficulty urinating. The following neonatal case report of perforated bladder includes a review of the signs, symptoms, diagnostic tools, and management of bladder injury in neonates.

Bladder perforations in children.

Bladder perforations in children occur due to several different reasons. In this clinical series study, we focused on bladder perforations due to the pelvic injury, and our aim also was to create awareness for a rare type of bladder injuries. This was a retrospective study of the patients who were treated in our clinic for bladder perforation between 2006 and 2011. We reviewed the documents of childhood bladder perforations, and demographic and clinical characteristics of the patients were obtained. No statistical analyses were used because of the limited number of cases. There were ten patients who suffered from bladder perforation in 5-year period; 5 were male, and 5 were female. The mean age of the patients was 4.35 years. Four patients (40%) experienced iatrogenic perforation and six patients (60%) experienced perforation due to the accident. Common symptoms were hematuria, abdominal tenderness, and inability to urinate. Three patients were diagnosed via emergency laparotomy, without any radiological examinations performed before surgery. Four patients suffered from the intraperitoneal perforation, three patients suffered from extraperitoneal injury and three of them both of intraperitoneal and extraperitoneal injuries. Mean recovery time for patients was 15 days. One patient developed a urinary tract infection and one newborn died due to accompanying morbidities. Nine patients were discharged from the hospital. If the patients had a pelvic injury, surgeons must pay attention for the bladder perforation. Isolated bladder perforations are rare, and they are generally associated with iatrogenic injuries. Clinicians should pay attention to findings such as anuria, inability to insert a urinary catheter, and free fluid in the abdomen in order to diagnose the bladder perforation in newborns. Novice surgeons should pay more attention to avoid causing iatrogenic bladder perforation during inguinal hernia repair.

Laparoscopic repair of iatrogenic bladder perforation during transurethral bladder tumor resection: Case report and literature review

An intraperitoneal bladder perforation occurred during transurethral tumor resection under general anesthesia in a 82 year old woman. The bladder was repaired with a laparoscopic closure and an indwelling urethral catheter. The histopathology revealed T1 high grade urothelial carcinoma. The patient recovered well and was discharged home on postoperative day 7. This case highlights the successful use of laparoscopy in the treatment of a rare urological complication.

Iatrogenic Bladder Perforation During Catheter Implantation for Peritoneal Dialysis in a Patient with Diabetic Neurogenic Bladder

복막 도관의 삽입 과정 중 드물게 방광 천자가 발생할 수있으며, 신경인성 방광이 발생할 수 있는 당뇨병 환자에서는 특별히 주의를 기울여야 할 것으로 생각된다. 맹시술법에 의한 복막투석 도관 삽입으로 인한 복막내 방광 파열 후 복막염이나 패혈증의 증거가 없어서, 도뇨관 유치 및 예방적 항생제 사용 등의 보존적 치료로 성공적으로 치료한 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Iatrogenic neonatal bladder perforation

Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of a 3-day-old infant with ascites due to bladder perforation secondary probably to manual decompression of the bladder. The infant underwent successful surgical repair of the perforation.

Iatrogenic Bladder Rupture Presenting with Diffuse Subcutaneous Emphysema

Iatrogenic bladder rupture is not an uncommon complication, especially during transurethral endoscopic procedures. Gross hematuria is the most frequent indication, along with lower abdominal pain and inability to void. However, subcutaneous emphysema is a rare sign of bladder perforation and can lead to misdiagnosis, especially when associated with acute abdomen. Here, we describe an uncommon case of iatrogenic bladder perforation presenting with pneumoperitoneum and diffuse subcutaneous emphysema. The patient underwent urethrocystoscopy and cystoscopic evacuation of blood clots after which abdominal pain was present. A computed tomography (CT) scan revealed diffuse subcutaneous emphysema in the abdomen, chest, and neck as well as pneumoperitoneum, but no pneumothorax or intraperitoneal fluid accumulation was identified. Intraperitoneal bladder perforation was confirmed by diagnostic laparoscopy, and open repair was performed. The patient recovered well after surgical repair, and the subcutaneous emphysema resolved a few days latter.

Complications of Retained Intraperitoneal Gallstones From Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is now the gold standard procedure for the treatment of symptomatic gall bladder stones. Spillage of gall bladder stones into the peritoneal cavity may occur due to inadvertent iatrogenic gall bladder perforation during dissection of the gall bladder. We report a case of a 66 year old woman who had to return to theatre three times over two years to deal with complications from retained intra-peritoneal gallstones that were spilt at her initial laparoscopic cholecystecomy.