Pelvic Surgery Patients Research Articles

Iatrogenic Vascular Injuries in Elective Abdominal and Pelvic Surgery Patients: Retrospective, Single Center, 30-Day Results.

Although rare, vascular injuries are common in elective abdominal or pelvic surgeries. When encountered, any problem in the relevant artery/vein (occlusion, stenosis, dissection, pseudoaneurysm or arteriovenous fistula) is associated with mortality and morbidity in both the short and long term. We aimed to share our treatment approach and short-term results for vascular injuries in elective surgery. In this study, the clinical data of patients who underwent elective abdominal and pelvic surgery performed by a vascular surgeon and who sustained iatrogenic vascular injury between January 2018 and July 2023 were retrospectively examined. All patients with no iatrogenic vascular injuries were excluded from the study. In the present study, a total of 72 patients had iatrogenic vascular injuries and underwent vascular surgery. The average age of the patients was 50.8±14.6 years. Twenty-eight (38.8%) of the patients were male, and 44 (61.1%) were female. Iatrogenic vascular injury occurred in 21 (29.2%) patients who underwent urologic surgical interventions, 35 (48.6%) who underwent gynecologic surgical treatments, and 16 (22.2%) who underwent abdominal surgeries. Twenty-nine patients had isolated arterial injuries, 37 patients had isolated venous injuries, and 6 patients had both arterial and vein injuries. Embolectomy was performed on 24 patients. Primary sutures were applied in 22 patients, end-to-end anastomosis with a vein graft was performed in 13 patients, and end-to-end anastomosis with Dacron/PTFE was performed in 11 patients. In 10 patients, native vein end-to-end anastomosis was performed. During the 30-day follow-up period, 3 patients experienced arterial occlusion, and 2 patients experienced venous thrombosis. There was no mortality in the hospital or during the 30-day follow-up period. Vascular injuries rarely occur in elective abdominal and pelvic surgeries. However, when they happen, they are fatal. For this reason, preoperative, multidisciplinary evaluation will minimize the risk of vascular complications, especially in patients requiring mass excision and lymph node dissection with close vascular proximity.

Effect of Perioperative Nursing on the Prevention of Lower Extremity Deep Vein Thrombosis in Patients Undergoing Gynecological Pelvic Surgery

Background: Deep venous thrombosis (DVT) is a common complication of gynecological pelvic surgery. DVT focuses on prevention. How to make a detailed perioperative nursing plan and organize its implementation of the measures is a great significance for the prevention of DVT in patients undergoing gynecological pelvic surgery. Objective: To investigate the effect of perioperative nursing intervention measures on the prevention of lower extremity deep vein thrombosis (DVT) in patients undergoing pelvic surgery in gynecology. Methods: Set up a project improvement activity group, analyzation the reason of gynecological pelvic surgery patients with DVT, and development a detailed plan of perioperative nursing intervention measures. Organizing the implementation of “one-on-one” nursing intervention, the problems in the nursing process were collected and formulated solutions, inspection gaps in care, made up the nursing error and improved nursing content. It was used to improve the quality of preventive measures and promote their implementation by “plan-do-check-action” (PDCA) cycle. Results: The perioperative preventive measures were continuously improved with PDCA cycle. The incidence of DVT in patients with pelvic surgery in our gynecological ward decreased from 6.96% to 2.08%. The anus exhausting time, resumption of eating time, defecation time and first leaving bed time of perioperative nursing group were shorter than before of the project improvement activities. The hospitalization time of patients was also significantly shortened. The differences were statistically significant (<i>P</i> < 0.05). Through the follow-up survey, patients' satisfaction with nursing increased from 82.6% to 95.0%. Conclusion: Through the development of detailed perioperative nursing plan and promotion the implementation of the measures with PDCA cycle continuously improved for the prevention of DVT in patients undergoing gynecological pelvic surgery, the incidence of postoperative lower extremity DVT could be effectively reduced and also promote the rehabilitation of postoperative. It was significantly shortened in the hospitalization time of patients, and improved the satisfaction of patients in perioperative nursing.

Urinary and Fecal Diversion Following Pelvic Exenteration: Comparison of Double-Barrelled and Plain Wet Colostomy.

To assess early and late-term outcomes of patients who had undergone pelvic exenteration and simultaneous fecal and urinary diversion with plain wet colostomy (PWC) or double-barrelled wet colostomy (DBWC). The medical records of all patients who had undergone pelvic exenteration and urinary diversion between 2006 and 2017 at our hospital were reviewed retrospectively. In total, 15 patients with a mean age of 56 ± 13 years were included in the study. Simultaneous urinary and fecal diversions were carried out as PWC (n = 8), or DBWC (n = 7). No significant differences were found between PWC and DBWC groups in terms of operation time (373.7 ± 66.5 versus 394.2 ± 133.2 min, P = .955), estimated blood loss (862.8 ± 462.4 versus 726.2 ± 489.4 mL, P = .613), length of hospital stay (13.2 ± 9.1 versus 14.1 ±6.9 days), early complications (25% versus 28.6%, P = 1.0) and late term complications (37.5% versus 42.9%, P = 1.0). The rate of recurrent pyelonephritis in PWC group was higher than DBWC group but not statistically significant (37.5% versus 14.3%, P = .569). Overall survival (OS) of the patients was 385 ± 91 days. There was no difference between OS of patients with PWC and DBWC (414 ± 165 versus 352 ± 70 days, P = .618). PWC and DBWC are valid options for creating simultaneous urinary and fecal diversion after extensive pelvic surgery in patients with short life expectancy. DBWC might be superior to PWC in terms of decreased risk of recurrent pyelonephritis.

Does the anesthetic technique influence the epinephrine and norepinephrine concentration during pelvic surgery?

Background: Epinephrine and norepinephrine concentrations increase by up to ten-fold immediately after surgical injury depending on the severity of the injury. However, the plasma levels of epinephrine and norepinephrine do not necessarily increase concurrently. The plasma epinephrine levels increase for about 48 h, while the norepinephrine levels remain elevated for about 8-10 days after injury. The choice of anesthesia has been shown to influence the secretion of epinephrine and norepinephrine. Materials and Methods: We compared the effects of balanced combined spinal-epidural anesthesia (CSEA, n = 20) and general anesthesia relaxant (GAR, n = 20) on epinephrine and norepinephrine concentrations during major pelvic surgery in patients with uterine mass > 20 weeks gestation. Blood samples for epinephrine and norepinephrine were analyzed at preinduction and 1, 3, and 4 h after surgical incision using enzyme-linked immunosorbent assay technique. Results: The mean norepinephrine concentration differs significantly after incision; at 1 h, CSEA 230.11 ± 42.85 versus GAR 51.25 ± 29.15 pg/ml, P = 0.015; and at 3 h, CSEA 116.22 ± 39.91 versus GAR 27.00 ± 19.89 pg/ml, P = 0.045. The norepinephrine concentrations increased from preinduction values after incision; at 1 h, increased in CSEA by +168% but increased in GAR by +31.7%; at 3 h, increased in CSEA by +35.64% but decreased in GAR by -22.85%; while at 4 h, decreased in CSEA by −3.37% but increased in GAR by +38.94% , P = 0.04 [Figure 2]. The mean epinephrine was comparable during the study, P > 0.05, while the mean heart rate, mean arterial blood pressure, and estimated blood loss were significantly lower with CSEA. Conclusion: We have demonstrated that in patients with uterine mass >20 weeks gestation, CSEA when compared to general anesthesia resulted in an initial increase in mean norepinephrine concentration 1 h after surgical incision followed by gradual decrease toward preinduction values.

Una oportunidad más

Sr. Editor En septiembre de 2011, la Sociedad Canadiense de Obstetricia y Ginecología recomendó discutir con las pacientes el beneficio de la salpinguectomía bilateral al momento de la histerectomía y en las pacientes que solicitan anticoncepción irreversible(1), y en noviembre de 2013 la Sociedad Ginecología Oncológica Americana recomendó la salpinguectomía bilateral de manera sistemática en la histerectomía benigna y en lugar de ligadura de trompas. Además, introdujo el concepto de salpinguectomía ‘oportunista’, es decir considerarla al momento de otra cirugía pelviana en pacientes mayores de 35 años con paridad cumplida(2). Sin embargo, no existe hasta el momento evidencia suficiente para recomendar que una paciente ingrese al quirófano única y exclusivamente para salpinguectomía electiva, sin otra indicación.

MP80-17 URINARY SYMPTOMS PERSIST IN YOUNG COLORECTAL SURVIVORS WHO UNDERWENT PELVIC SURGERY AT LONG-TERM FOLLOW-UP

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 2014MP80-17 URINARY SYMPTOMS PERSIST IN YOUNG COLORECTAL SURVIVORS WHO UNDERWENT PELVIC SURGERY AT LONG-TERM FOLLOW-UP Maura Livengood, Y. Nancy You, Chung-Yuan Hu, Christina E. Bailey, Hop S. Tran Cao, Sa T. Nguyen, and O. Lenaine Westney Maura LivengoodMaura Livengood More articles by this author , Y. Nancy YouY. Nancy You More articles by this author , Chung-Yuan HuChung-Yuan Hu More articles by this author , Christina E. BaileyChristina E. Bailey More articles by this author , Hop S. Tran CaoHop S. Tran Cao More articles by this author , Sa T. NguyenSa T. Nguyen More articles by this author , and O. Lenaine WestneyO. Lenaine Westney More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2540AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary dysfunction after resection of the rectum is reported to occur in 30 – 70% of cases. Controversy exists regarding whether symptoms reported in long-term survivors are related to the age-related changes in the lower urinary tract or as a continued direct consequence of surgical compromise to the autonomic nerves. We sought to compare the urinary symptoms in young long-term colorectal cancer (CRC) survivors who underwent resection of the rectum (pelvic) versus colon resection (non-pelvic). METHODS Our Institutional Tumor Registry was queried to identify young adult patients with CRC (diagnosis: 18-50 yrs) who were alive > 5 years from their diagnosis. Demographics, tumor characteristics and treatment details were extracted from the medical record. Patients were mailed self-administered standardized surveys - European Organization for Research and Treatment of Cancer (EORTC) C30 (generic cancer quality of life) and CRC disease specific module (CR29). Within the CR29, four urinary symptom items (Likert scale: 1-4) are included that address frequency, nocturia, incontinence and dysuria. Descriptive statistics and t-test of the raw and linearized scores were performed. RESULTS Of 415 young CRC patients, 282 patients responded (response rate: 68%). Seventeen patients were excluded based on route of surgery, concomitant cystectomy or missing clinical information. The remaining 265 patients had a mean age of 43.3 yrs. and follow-up of 125.5 months (SD, 40.1) with 133 and 132 having undergone non-pelvic and pelvic surgery, respectively. Based on analysis of the CR29 urinary items, frequency, nocturia and incontinence were significantly higher in patients who underwent pelvic surgery. (Table I) Radiation was not associated with increased urinary symptoms in the pelvic surgery patients. CONCLUSIONS Young long-term CRC survivors with pelvic surgery were more likely to describe frequency, nocturia and incontinence as occurring ‘quite a bit’ (3) or ‘very much’ (4) in comparison to patients who underwent colon resection only. Further work will need to be done to determine whether moderate to severe symptoms detected on the EORTC CR 29 correlate with identifiable functional abnormalities in the lower urinary tract. A direct association would create an objective signal for urologic evaluation. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e944 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Maura Livengood More articles by this author Y. Nancy You More articles by this author Chung-Yuan Hu More articles by this author Christina E. Bailey More articles by this author Hop S. Tran Cao More articles by this author Sa T. Nguyen More articles by this author O. Lenaine Westney More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Venous Thrombo-embolism prophylaxis: Intermittent pneumatic compression

Abstract Pulmonary embolism (PE) is the most preventable cause of hospital deaths in Europe. Autopsy-proven fatal pulmonary emboli were found in 2.5% of 200 hospitalized medical patients followed-up prospectively. The number of venous thrombo-embolism (VTE) related deaths throughout the Europe (543,454) is more than double the amount of deaths attributed to AIDS, breast cancer, prostate cancer and transport accidents combined (209,926). Only 58.5% of surgical patients and 39.5% of medical patients receive the appropriate thrombo-prophylaxis for their conditions. An ideal VTE prophylaxis for any given patient should be (1) risk adjusted, (2) targeted, (3) personalized and (4) effective. Intermittent pneumatic compression (IPC) devices are best suited for: (1) ICU patients who are either bleeding or have a high bleeding risk; (2) low risk elective general abdominal or pelvic surgery patients; (3) high risk elective general abdominal or pelvic surgery patients who have a high bleeding risk. In high risk elective general abdominal or pelvic surgery patients who are not at high risk for major bleeding, combined prophylaxis (IPC+LMWH) are recommended. Combined modalities target virtually all aspects of the Virchow's triad: (1) IPC and stockings prevent “stasis”, (2) stockings prevent “endothelial damage”, (3) IPC increases fibrinolysis, and LMWH exert anti-thrombotic effects to prevent “hypercoagulability”. In patients undergoing major surgery, IPC devices have a broader area of application due to fewer contra-indications and similar efficacy as compared to LMWH. Whenever indicated, every effort should be undertaken to provide a combined prophylaxis method.

Urinary Ascites: Cryptic Presentation of Unrecognized Urinary Bladder Injury

A case of urinary ascites in a 37-year-old woman caused by an unrecognized bladder injury inflicted during hysterectomy done seven months earlier is presented here. The site of injury was located by conventional retrograde cystography and repaired by laparotomy. The medical record suggesting uneventful peri and postoperative period, absence of expected typical changes in serum biochemistry and the unusual aetilogy of the ascites led to the delay in the diagnosis.The case demonstrates the importance of high index of suspicion of bladder injury following pelvic surgery in patients with ill-defined symptoms and unexplained ascites even in the absence of typical biochemical changes. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12364 Birdem Med J 2012; 2(1) 60-62

Robotic Transperitoneal Infrarenal Aortic Lymphadenectomy for Gynecologic Malignancy: A Left Lateral Approach

Objective: To describe the technique of a left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy with subsequent pelvic surgery in patients with gynecologic malignancy. Methods: Our surgical technique utilized an extreme right tilt position to obtain optimal exposure of bilateral aortic regions. A total of six trocars were used for both the aortic and pelvic dissections. The robot was docked over the left hip. The dissection began left lateral with transperitoneal mobilization of the ureter and descending colon. The cephalad borders of the dissection were the left renal vein and the right gonadal vein insertion. After the aortic dissection, sterility was maintained and the operating table rotated 45° degrees for caudal docking during pelvic surgery. Patient outcome data were collected and analyzed.1 Results: The median total operating time was 213 minutes (range, 186–265) for all procedures. All patients underwent concomitant robotic hysterectomy and pelvic lymphadenectomy. The mean number of para-aortic lymph nodes was 8.2 (range 4–17). There were no conversions or perioperative complications. Conclusions: A left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy using a right lateral decubitus position is safe and feasible. Minimal patient repositioning provides access for pelvic surgery using the same abdominal trocar placement. No competing financial interests exist. Runtime of video: 5 mins 5 secs

Robotic Transperitoneal Infrarenal Aortic Lymphadenectomy for Gynecologic Malignancy: A Left Lateral Approach

To describe the technique and report patient outcomes of a left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy with subsequent pelvic surgery in patients with gynecologic malignancy. Outcome data were collected retrospectively from March 2009 to September 2010 for all patients undergoing a left lateral approach for robotic transperitoneal aortic lymphadenectomy using a right lateral decubitus position by a single surgeon. Outcomes were analyzed and compared. The median total operating time was 213 minutes (range, 186-265). The median body mass index was 25.2 kg/m(2) (range, 22.5-32.1). The median estimated blood loss was 150 mL (range, 50-550). The median length of hospital stay was 1 day (range, 1-2). The mean number of para-aortic lymph nodes was 8.2 (range 4-17). There were no conversions or perioperative complications in this 5-patient series. The mean follow-up was 12.8 months (range, 8-20). All patients underwent concomitant robotic hysterectomy and pelvic lymphadenectomy. A left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy using a right lateral decubitus position is safe and feasible. Minimal patient repositioning provides access for pelvic surgery using the same abdominal trocar placement.

Evoked cavernous activity: neuroanatomic implications

We investigated the autonomic innervation of the penis by using evoked cavernous activity (ECA). We recruited 7 males with thoracic spinal cord injury (SCI) and sexual dysfunction and 6 males who were scheduled to have pelvic surgery (PS), specifically non-nerve-sparing radical cystoprostatectomy. In the PS subjects, ECA was performed both pre- and postoperatively. The left median nerve was electrically stimulated and ECA was recorded with two concentric electromyography needles placed into the right and left cavernous bodies. We simultaneously recorded hand and foot sympathetic skin responses (SSRs) as controls. In the SCI group, all but one subject had reproducible hand SSRs. None of these subjects had ECA or foot SSRs. All the PS subjects had reproducible ECA and SSRs, both preoperatively and postoperatively. There was no difference in the latency and amplitude measurements of ECA and SSRs in the postoperative compared to the preoperative period (p>0.05). In conclusion, ECA is absent in men with SCI above the sympathetic outflow to the genitalia. In men following radical pelvic surgery, ECA is preserved, indicating the preservation of sympathetic fibers.

Survey of clinical practice: pre‐ and postoperative physiotherapy for pelvic surgery

The objective of this survey was to obtain information about current physiotherapy practice for patients undergoing pelvic surgery. The aims were to evaluate whether differences exist in service provision between women's health physiotherapists (WHPTs) and hospital physiotherapists (HPTs) and in the guidelines used by physiotherapists to direct their service delivery. METHODS. A questionnaire was posted to the members of the Victorian Continence and Women's Health Physiotherapy Group (n = 130) and physiotherapists working in metropolitan and rural hospitals (n = 90). The questionnaire comprised questions relating to the aspects of treatment, including how referrals are made, funding, interventions provided and how they are delivered, and use of outcome measures. Data were summarized using descriptive statistics and Chi-square analysis of differences between WHPTs and HPTs. The response rate was 75.9%. In 67% of cases, service delivery was initiated by surgeon request, and most commonly for gynecologic patients (85%). Individual consultations were used on 96% of occasions and 8% were group sessions. Content of physiotherapy treatment for in-patients varied, with WHPTs significantly more likely to prescribe pelvic floor muscle exercises (P = 0.003), bowel advice (P = 0.001), avoidance of risk activities (P = 0.002), and awareness of postoperative symptoms (P = 0.001). Conversely, HPTs were significantly more likely to perform respiratory checks (P = 0.002) and mobilization (P = 0.001). Eighty-seven percent of respondents regarded their service as suboptimal, citing the need for evidence to support the content and best timing of intervention. Differences exist in physiotherapy treatment for pelvic surgery patients. Further research is required to establish whether, and which, elements of physiotherapy intervention are effective.

Survey of clinical practice: pre- and postoperative physiotherapy for pelvic surgery

Background. The objective of this survey was to obtain information about current physiotherapy practice for patients undergoing pelvic surgery. The aims were to evaluate whether differences exist in service provision between women's health physiotherapists (WHPTs) and hospital physiotherapists (HPTs) and in the guidelines used by physiotherapists to direct their service delivery. Methods. A questionnaire was posted to the members of the Victorian Continence and Women's Health Physiotherapy Group (n = 130) and physiotherapists working in metropolitan and rural hospitals (n = 90). The questionnaire comprised questions relating to the aspects of treatment, including how referrals are made, funding, interventions provided and how they are delivered, and use of outcome measures. Data were summarized using descriptive statistics and Chi-square analysis of differences between WHPTs and HPTs. Results. The response rate was 75.9%. In 67% of cases, service delivery was initiated by surgeon request, and most commonly for gynecologic patients (85%). Individual consultations were used on 96% of occasions and 8% were group sessions. Content of physiotherapy treatment for in-patients varied, with WHPTs significantly more likely to prescribe pelvic floor muscle exercises (P = 0.003), bowel advice (P = 0.001), avoidance of risk activities (P = 0.002), and awareness of postoperative symptoms (P = 0.001). Conversely, HPTs were significantly more likely to perform respiratory checks (P = 0.002) and mobilization (P = 0.001). Eighty-seven percent of respondents regarded their service as suboptimal, citing the need for evidence to support the content and best timing of intervention. Conclusion. Differences exist in physiotherapy treatment for pelvic surgery patients. Further research is required to establish whether, and which, elements of physiotherapy intervention are effective.

Systematic review: Abdominal and pelvic surgery in patients with irritable bowel syndrome.

To systematically review research on the prevalence of abdominal and pelvic surgery in patients with irritable bowel syndrome. Computer searches of MEDLINE, EMBASE and Current Contents were performed independently by both investigators to identify appropriate studies. Primary study selection criteria included: (i) population-based samples of adult irritable bowel syndrome patients; (ii) the use of appropriate symptom-based criteria to identify irritable bowel syndrome patients; and (iii) comparison of the prevalence of abdominal and pelvic surgery in irritable bowel syndrome patients vs. control populations. Secondary analysis was performed on published studies of referral populations and case series. Two population-based studies met the primary study selection criteria and revealed an increased prevalence of surgery in irritable bowel syndrome patients vs. controls for cholecystectomy (4.6% vs. 2.4%, respectively; odds ratio, 1.9; 95% confidence interval, 1.2-3.2) and hysterectomy (18% vs. 12%, respectively; odds ratio, 1.6; 95% confidence interval, 1.1-2.2). Secondary analysis revealed an increased prevalence of appendectomy and other abdominal and pelvic surgery in irritable bowel syndrome patients. Irritable bowel syndrome is associated with a disproportionately high prevalence of abdominal and pelvic surgery, but most studies exhibit sub-optimal study design and do not define the factors causing the increased prevalence of surgery in these patients.

Ventral, subcoronal, and penoscrotal penile approach for semirigid rod penile prostheses

Autologous cartilage and bone grafts that are used for internal splinting as prosthetic materials have been performed historically, but long-term results have been poor [1]. Advances in treatment enabled the use of synthetic materials (acrylic rods), as described by Goodwin and Scott in 1952 [3]. Semirigid rod penile prostheses were introduced in the early 1970s, relatively close to the advent of hydraulic prostheses. Initially, semirigid rod implants readily were accepted because of the relative simplicity of insertion and use. Although semirigid rod and hydraulic implants have a high rate of satisfaction, the inflatable or hydraulic prostheses now make up more than 90% of the market. Inflatable prostheses are more desirable in terms of increased rigidity and flaccidity. Nonetheless, semirigid rod penile prostheses are still applicable and have potential advantages, including: • Low rate of mechanical failure • Adequacy of erections • Ease of insertion • Extensive applicability to pelvic surgery patients • Little manual dexterity needed for operation • Less anxiety, compared with the anxiety of cycling a hydraulic device • Lower financial costs and operating time • Aid in placement of external condom catheter in spinal cord Disadvantages include a greater risk for pressure necrosis from the rods compared with the risk with inflatable devices, especially in patients with absent or decreased penile sensation. This problem results from the lack of flaccidity, a disadvantage that makes inflatable devices are more marketable. Another disadvantage is the increased difficulty in peforming endoscopy. Semirigid rod prostheses are available as malleable or mechanical types (Table 1). The mechanical prosthesis from Timm Medical Technologies (Eden Prairie, MN) primarily is composed of polyethylene segments and an outer layer of silicone. The malleable prostheses, available from American Medical Systems (Minnetonka, MN) and Mentor (Santa Barbara, CA), are designed as a core of bendable wire with a silicone sheath.