Urinary Tract Injury Research Articles

Management of children with kidney injuries of various severity: a series of clinical observations

BACKGROUND: Kidney injury takes approximately 1–5% of all urinary tract and abdominal cavity injuries. Children blunt trauma amounts more than 90% of all kidney damages. Kidney injury is always followed by pain in the lumbar region and abdomen as well as by hematoma and hematuria. Serious renal injuries in children are more often accompanied by stable vital functions and normal general urine analyses compared to adults. Such patients require dynamic observation and instrumental examination so as to determine further curative strategy. CLINICAL CASE DESCRIPTION: This article describes three clinical cases of kidney injury in children. In the first case, ultrasound examination and computed tomography revealed contusion changes in the kidney, subcapsular hematoma and renal parenchyma rupture without damage of the collecting system. Due to clinical findings, ultrasound and computed tomography examination, conservative management was prescribed to one patient, while for the other two with renal parenchyma rupture — surgery. One of these patients had malformation — a gap between the upper and lower segments of the double kidney. Such malformation could aggravate the injury. CONCLUSION: The present series of clinical observations is an example of managing children with kidney injuries of varying severity. Depending on the damage severity, conservative management or surgical tactics are chosen by specialists.

Diagnosis and treatment of abdominally inserted (sacrocolpopexy/sacrohysteropexy) mesh complications for vault/uterine prolapse

Background:Sacrohysteropexy and sacrocolpopexy are established treatments of uterine or vaginal vault prolapse respectively and involve insertion of mesh abdominally, often using permanent sutures and fixation devices. Complications following these procedures may be serious, and there is lack of evidence about long-term functional outcomes in terms of pain, dyspareunia and development of lower urinary tract and bowel symptoms. Objective:A non-systematic review of the available literature was performed and recommendations on assessment and management were developed by expert consensus. Conclusion:The current evidence is limited in quantity and quality, and recommendations on assessment management of mesh-related complications were made by experts in the field. Assessment and treatment of complications following abdominally placed mesh for pelvic organ prolapse will often require a multidisciplinary approach. Assessment may require EUA, and/or cystourethroscopy, sigmoidoscopy, and laparoscopy. MRI is the most useful imaging modality. Surgery to remove meshcarries a risk of urinary tract and bowel injury, as well as development of recurrent pelvic organ prolapse. A joint decision between the surgeon and the patient should be made before embarking on a partial removal of mesh; removal of all the mesh may be a better option albeit with higher risk of surgical complications. Complete removal of mesh and tacks or sutures from the sacral attachment may not be possible and is associated with risk of major haemorrhage.

Interdisciplinary Management of Traumatic Injuries to the Kidneys and Urinary Tract Caused by Blunt Abdominopelvic Trauma.

Purpose: Blunt abdominopelvic trauma frequently results in injuries to the urinary organs, especially in polytrauma. The urotrauma is rarely an acute life-threatening event; however, it may lead to severe complications. Methods: This review addresses the under-representation of urological trauma management in interdisciplinary medical training and its impact on patient outcomes. It compiles evidence-based recommendations and guidelines from multiple specialties, focusing on common challenges in managing these injuries. The resource is tailored for primary care physicians in radiology, trauma surgery, internal medicine, urology, and nephrology. Results: Urinary tract injuries can occur even if the patient's condition initially appears normal. An exclusion diagnosis is obligatory by contrast medium tomography of the entire urinary tract and, if suspected, an additional uroendoscopic examination. Interventional therapy by catheterisation of the urinary tract is often required. Urosurgical treatment is not commonly needed, but when there is a demand, it must be administered via an interdisciplinary approach with visceral and trauma surgery. Over 90% of life-threatening kidney injuries (usually up to grade 4-5 AAST) are presently treated by interventional radiologists. Acute kidney injury (AKI) as a complication in trauma patients may complicate clinical management and often worsens the outcome. The incidence of trauma-associated AKI in patients admitted to an intensive care unit is high. Conclusions: Patients suffering from blunt abdominopelvic trauma should ideally be referred to certified trauma centres with subspecialised or fully specialised care provided by visceral/vascular surgery, trauma surgery, interventional radiology, urology, and nephrology. This recommendation is based on the complex nature of most damage patterns.

In-hospital outcomes of repair and hysterectomy for uterine rupture: A nationwide observational study

ObjectiveUterine rupture, though rare, poses significant risks to both mother and child. Its occurrence varies globally, with a noted 0.015% prevalence in Japan. This condition usually requires surgical intervention, either as uterine repair or hysterectomy. Past studies, largely single-center and outdated, offer limited insights into these treatment options. To assess and compare the clinical outcomes of repair and hysterectomy for uterine rupture among patients included in a large inpatient database in Japan. Study designWe analyzed the Diagnosis Procedure Combination inpatient database from July 2010 to March 2022. Patients with uterine rupture who underwent uterine repair or hysterectomy were extracted. Patient characteristics, in-hospital care, and outcomes were compared between the uterine repair group and the hysterectomy group. Main outcomes are reoperation during hospitalization, total volume of blood transfusion, complications (bowel injury, urinary tract injury, wound infection, deep vein thrombosis, or pulmonary embolism), maternal mortality, and postoperative length of stay. ResultsWe identified 644 patients with uterine rupture. Of those, 287 (44.6 %) underwent uterine repair and 357 (55.4 %) underwent hysterectomy. The hysterectomy group was significantly older, had significantly more comorbidities, and had a significantly higher prevalence of consciousness impairment than the uterine repair group. Compared with the uterine repair group, the hysterectomy group required significantly more in-hospital care and had a significantly greater incidence of reoperation (1.0 % versus 6.4 %; P<0.001). Other complications were not significantly different between the groups. The hysterectomy group had significantly more blood transfusions and a significantly longer postoperative length of hospital stay than the uterine repair group. The results remained consistent even after the adjusted analysis. ConclusionThis study highlights the differences between repair and hysterectomy for uterine rupture, providing valuable insights for clinical decision-making in these cases.

Comparison of surgical outcomes between manual free vaginal morcellation and no vaginal morcellation for uterine extraction during total laparoscopic hysterectomy: Retrospective cohort study

Aim: We aimed to compare the surgical outcomes between manual free vaginal morcellation and no vaginal morcellation for uterine extraction during total laparoscopic hysterectomy (TLH) performed in a tertiary center. Materials and Methods: A total of 397 TLH either with or without oophorectomy, for a benign indication, surgeries performed at our tertiary hospital between March 2022 and May 2024 were analyzed in our study. Patients who underwent manual free vaginal morcellation were defined as Group I (n=85, 21.4%) and patients who did not undergo vaginal morcellation were defined as Group II (n=312, 78.6%). Demographic characteristics, laboratory values, operation characteristics and histopathological reports were accessed from the hospital database. Results: The median uterine weight of the morcellation group was greater. Median morcellation time was 9 minutes. While the median operation time of Group I was 80 minutes, it was 70 minutes for Group II. The groups were similar with regard to postoperative urinary tract, intraoperative urinary tract and intraoperative bowel injuries. Intraoperative vaginal or perineal laceration was detected at a greater rate in the morcellation group. Conclusion: For large uteruses, TLH is still the best option for suitable patients when performed by experienced surgeons. It has been revealed that manual free vaginal morcellation, performed without the need for additional incisions, is safe, low-cost and practical in total laparoscopic hysterectomies with benign indications.

Relation of Pre-operative Ureteral Catheter Use and Complications of Intraoperative Ureteral and Bladder Trauma in Gynecologic Oncology Patients Undergoing Major Surgical Procedures

Iatrogenic injury to the urinary tract is a potential complication of all surgical procedures performed in or retroperitoneum and pelvis. Gynecological surgery in particular has a risk of urinary tract injury due to the close anatomy of the urinary tract and the reproductive system in women. This study aimed to evaluate the relation between pre-operative ureteral catheter use and complications of intraoperative ureteral and bladder trauma in gynaecologic oncology patients undergoing major surgical procedures. This study used cohort data of patients undergoing major surgical procedures at Prof. Dr. R. D. Kandou Hospital, Manado, recorded in medical records from January 1, 2023 to June 30, 2023. The bivariate test showed that patients who received pre-operative ureteral catheter insertion had fewer urological trauma events (4.5%) compared to patients who did not get pre-operative ureteral catheter (95.5%). The relations between pre-operative ureteral catheters and the incidence of urological trauma was found to be statistically significant with a p-value of 0.019 and the history of chemotherapy had a p-value of 0.036, meanwhile the relations with other variables showed p-values of &gt;0.05. Therefore, the use of pre-operative catheters could not significantly eliminate the occurrence of ureteral trauma because many of the confounding factors were accompanied by several other conditions that were also studied in the multivariate analysis. In conclusion, there is no association between the use of pre-operative ureteral catheters and complications of intraoperative ureteral trauma in gynecologic oncology patients undergoing major surgical procedures. Future studies using samples from more sources are expected to assess the relation between pre-operative ureteral catheter use and the incidence of urological trauma more accurately, and to assess the ease of use of pre-operative ureteral catheter. Keywords: ureteral catheter; ureteral trauma; gynaecologic oncology patients

Radiologic feature of complications after artificial urinary sphincter implantation following total prostatectomy.

Incontinence following total prostatectomy for prostate cancer significantly impairs patient's quality of life. In severe cases, implantation of an artificial urinary sphincter (AUS) has shown favorable outcomes, enhancing continence by constricting the bulbous urethra. The AUS system consists of a pressure-maintaining balloon, control pump serving as the operational switch, cuff that constricts the urethra, and tubes and connectors that link these components, maintaining a continuous circuit through an internal pressure medium. Most instances of AUS dysfunction are attributed to circuit leaks leading to a reduction in internal pressure, which is identifiable on imaging by fluid accumulation around the circuit, balloon collapse, control pump deformation, and air within the circuit. When the AUS circuit is uncompromised, dysfunction may arise from issues such as the inability to compress the pump due to pain or displacement outside the scrotum or urinary tract obstruction caused by bladder hemorrhage/hematoma. Imaging plays a pivotal role in the evaluation of urinary tract injuries, hematomas/seromas, and infections associated with AUS placement or replacement. Understanding the function of AUS and its appearance on CT imaging is essential for accurately assessing AUS dysfunction and post-implantation complications, guiding clinical decision-making and improving patient care outcomes.

Characteristics and management of iatrogenic urinary tract injuries in teaching hospital: A single-centered study.

Despite its rarity, iatrogenic urinary tract injury can cause severe morbidity and mortality. The purpose of this study was to determine the frequency of urinary tract injuries caused by medical treatment in a hospital in Medan, Indonesia. This retrospective descriptive study was conducted at H. Adam Malik General Hospital and Universitas Sumatera Utara Hospital in Medan from March to August 2022. Medical data of individuals who had iatrogenic urinary tract injuries in a Medan teaching hospital from 2018 to 2022 were obtained using total sampling. SPSS version 25 was utilized to analyze patient characteristics, the type of surgery, urinary tract injuries, and urologic procedures. There were 11 ureteral injuries and 23 bladder injuries in 32 iatrogenic urinary tract injuries. The average age of the patients was 40.5 ± 13.3. Patients who received obstetrical care had the highest rate of iatrogenic urinary tract injury (56.3%), followed by patients who received gynecological care (21.9%) and surgical care (21.9%). The procedure most likely to cause iatrogenic urinary tract injury was hysterectomy (40.6%). Bladder rupture (65.5%) and ureteral transection (28.1%) were common types of iatrogenic bladder and ureteral injuries. Majority of iatrogenic urinary tract injuries were treated with bladder repair (68.8%). Obstetrical and gynecologic procedures, especially hysterectomy, were the most common causes of iatrogenic urinary tract injury; bladder repair was the most common treatment. Iatrogenic urinary tract injury is best managed by knowing the anatomical position of the urinary tract inside the operative field.

Реконструктивные операции у женщин с лучевыми повреждениями мочевыводящих путей: изменение парадигмы

Реконструктивные операции у женщин с лучевыми повреждениями мочевыводящих путей: изменение парадигмы

Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection.

To assess the feasibility of use of indocyanine green (ICG) in identifying and minimising urinary tract injury during surgical resection of endometriosis through robotic transvaginal natural orifice transluminal endoscopy surgery (RvNOTES). We conducted a retrospective case series in two academic tertiary care hospitals. We examined 53 patients who underwent RvNOTES hysterectomy with planned endometriosis resection. The study involved 53 patients undergoing RvNOTES with ICG fluorescence for endometriosis resection. Mean patient age was 37.98±6.65years. Operative time averaged 181.32±53.94min, with estimated blood loss at 45.57±33.62mL. Postoperative stay averaged 0.23±0.47days. No ICG-related complications occurred. No complications occurred with ICG fluorescence in RvNOTES. It appears to be a safe option for ureteral localisation and preservation. ICG fluorescence is widely used in diverse medical specialities for identifying ureters during complex surgeries. Larger studies are needed to firmly establish its advantages in intraoperative ureteral visualisation during RvNOTES for deep infiltrative endometriosis.

In vitro and in vivo enhancement effect of glabridin on the antibacterial activity of colistin, against multidrug resistant Escherichia coli strains

BackgroundThe increase in antimicrobial resistance leads to complications in treatments, prolonged hospitalization, and increased mortality. Glabridin (GLA) is a hydroxyisoflavan from Glycyrrhiza glabra L. that exhibits multiple pharmacological activities. Colistin (COL), a last-resort antibiotic, is increasingly being used in clinic against Gram-negative bacteria. Previous reports have shown that GLA is able to sensitize first line antibiotics such as norfloxacin and vancomycin on Staphylococcus aureus, implying that the use of GLA as an antibiotic adjuvant is a promising strategy for addressing the issue of drug resistance. However, the adjuvant effect on other antibiotics, especially COL, on Gram-negative bacteria such as Escherichia coli has not been studied. PurposeThe objective of our study was to investigate the targets of GLA and the synergistic effect of GLA and COL in E. coli, and to provide further evidence for the use of GLA as an antibiotic adjuvant to alleviate the problem of drug resistance. MethodsWe first investigated the interaction between GLA and enoyl-acyl carrier protein reductase, also called "FabI", through enzyme inhibition assay, differential scanning fluorimetry, isothermal titration calorimetry and molecular docking assay. We tested the transmembrane capacity of GLA on its own and combined it with several antibiotics. The antimicrobial activities of GLA and COL were evaluated against six different susceptible and resistant E. coli in vitro. Their interactions were analyzed using checkerboard assay, time-kill curve and CompuSyn software. A series of sensitivity tests was conducted in E. coli overexpressing the fabI gene. The development of COL resistance in the presence of GLA was tested. The antimicrobial efficacy of GLA and COL in a mouse model of urinary tract infection was assessed. The anti-biofilm effects of GLA and COL were investigated. ResultsIn this study, enzyme kinetic analysis and thermal analysis provided evidence for the interaction between GLA and FabI in E. coli. GLA enhanced the antimicrobial effect of COL and synergistically suppressed six different susceptible and resistant E. coli with COL. Overexpression experiments showed that targeted inhibition of FabI was a key mechanism by which GLA synergistically enhanced COL activity. The combination of GLA and COL slowed the development of COL resistance in E. coli. Combined GLA and COL treatment significantly reduced bacterial load and mitigated urinary tract injury in a mouse model of E. coli urinary tract infection. Additionally, GLA + COL inhibited the formation and eradication of biofilms and the synthesis of curli. ConclusionOur findings indicate that GLA synergistically enhances antimicrobial activities of COL by targeting inhibition of FabI in E. coli. GLA is expected to continue to be developed as an antibiotic adjuvant to address drug resistance issues.

Electrospun nanostructured heparin conjugated-poly-ε-caprolactone based scaffold promote differentiation of smooth muscle cells from adipose mesenchymal stem cells

BackgroundTissue engineering integrating cell-based approaches is promising for urinary tract injury treatments. PurposeExploring the Impact of Nanostructured Heparin Conjugated-Polycaprolactone (HPCL) on the differentiation of Adipose Mesenchymal Stem Cells (ADMSCs) into Smooth Muscle Cells (SMCs). MethodsPCL nanofibers were produced by electrospinning and conjugated with heparin. The surface properties of the scaffolds were analyzed using FE-SEM for imaging, FTIR for investigation of chemical structure, assessments of surface roughness, thermomechanical characteristics, and the contact angle to evaluate wettability. The study included six groups; Group I: ADMSCs cells, Group II: ADMSCs seeded on PCL, Group III: ADMSCs seeded on HPCL, Group IV: SMCs cells, Group V: SMCs seeded on PCL, and Group VI: MSCs seeded on HPCL. SMCs differentiation was evaluated using specific genes and proteins. ResultsImmobilization of heparin was confirmed by amide I (3427 cm−1) and it was significantly raised on HPCL scaffolds. SMCs + HPCL group revealed the highest cell viability and the most significant increase in differentiation-related genes and proteins at 7 days (p < 0.05). ConclusionHPCL nanofibers have an effect on SMCs differentiation, which are the functional units of the ureter. Therefore, they could represent a valuable tool for tissue engineering applications in ureter repair.

Idiopathic Ascites after Laparoscopic Appendicectomy: a review of literature and a case report

Introduction: Minimal access surgery, encompassing laparoscopy and robotic procedures, has become the preferred choice for a wide range of surgical interventions, receiving widespread acceptance from both surgeons and patients. However, as the utilization of these minimally invasive techniques continues to grow, surgeons are increasingly confronted with unforeseen and puzzling complications. One such rare and perplexing complication is the emergence of ascites following laparoscopic procedures, particularly when no accidental injury to the bowel or urinary system has occurred, posing a challenging and distressing scenario for the operating surgeon. Aims and Objective:We have encountered a case of idiopathic ascites following a laparoscopic appendicectomy in a 10-year-old boy. The primary objective of this study is to conduct a comprehensive literature review to identify similar case reports and publications. By doing so, we aim to enhance our understanding of the causes and principles for managing idiopathic ascites occurring after laparoscopic surgery. Methods: A 10-year-old boy was admitted to the hospital with typical symptoms of acute appendicitis. Following evaluation, a nearly bloodless and uneventful laparoscopic appendicectomy was performed. However, postoperatively, he developed ascites accompanied by scrotal swelling due to scrotal edema, and despite thorough evaluation, no identifiable cause was found. The patient was managed conservatively and fully recovered without any subsequent complications. Results: The occurrence of ascites stemming from an idiopathic allergic or inflammatory peritoneal reaction during a laparoscopic procedure is exceptionally rare. During the patient's evaluation, the paramount concern was to rule out potentially significant complications such as bowel or urinary tract injuries, which can commonly result in postoperative peritoneal fluid accumulation. After the procedure, the boy underwent a thorough evaluation, but no definitive cause for the ascites was identified, further highlighting the enigmatic nature of this condition. Conclusion: Postoperative ascites without a discernible cause following laparoscopic surgery is an unexpected complication. In such cases, the leading hypothesis points to a peritoneal inflammatory reaction induced by agents utilized during laparoscopy. J Bangladesh Coll Phys Surg 2024; 42: 194-198

Urinary tract injuries during hysterectomy for endometriosis: a NSQIP study

Urinary tract injuries during hysterectomy for endometriosis: a NSQIP study

Major placenta previa among patients with and without previous cesarean section: Maternal characteristics, outcomes and risk factors

ObjectivesTo compare maternal characteristics and outcomes among patients having major placenta previa (PP) with and without previous cesarean section (CS). And to determine if previous CS alone is a risk factor for associated adverse maternal outcomes in these patients. Materials and methodsThis is a retrospective analysis including two groups of major PP patients, with previous CS (n = 184) and without CS (n = 115); who were admitted to Abha Maternity and Children's Hospital over the last ten-years (January 2012–December 2021), Aseer region, Saudi Arabia. ResultsCompared to those without previous CS, major PP patients with previous CS had significantly advanced ages with higher mean numbers of gravidity and parity, but significantly less rates of previous uterine surgery and IVF pregnancies. Moreover, they were more likely to acquire higher rates of adverse maternal outcomes. In the same way, these patients had an increased Odds Ratios of cesarean hysterectomy (OR of 20.462), urinary tract injuries (OR of 12.361), associated PAS (OR of 4.375), moderate/ heavy intra-operative bleeding (OR of 2.153) and the need for transfusion of 3+ units of packed RBCs (OR of 1.849). Conclusion(1) Patients with combined existence of major PP and previous CS had significantly higher rates of adverse maternal outcomes (2) Alone, prior CS in major PP patients increased the Odds Ratios of cesarean hysterectomy, urinary tract injuries, diagnosis of PAS, excessive intra-operative bleeding and repeated packed RBCs transfusions. (3) Among our PP patients with previous CS, the increased rate and OR of PAS diagnosis could in-part explain the adverse maternal outcomes.

Lower urinary tract injury in transvaginal reconstructive pelvic surgery

Objective: To explore the characteristics, prevention and treatment strategies of lower urinary tract injury in transvaginal reconstructive pelvic surgery (vRPS). Methods: A retrospective analysis was conducted on 24 patients who suffered lower urinary tract injuries occuring in vRPS from January 2005 to June 2021, among which 4 cases were referred to our hospital from other hospitals. Results: (1) In our hospital, 1 952 patients underwent vRPS for anterior and (or) middle pelvic organ prolapse during that study period, with a 1.0% (20/1 952) incidence of lower urinary tract injuries occurring in 20 cases. (2) Ureteral injuries were observed in 14 cases who underwent transvaginal high uterosacral ligament suspension (1.4%, 14/966). The symptoms were relieved after the removal of sutures. (3) Bladder injuries occurred in 6 cases in our hospital, with 4 cases (0.7%, 4/576) in anterior transvaginal mesh surgery (aTVM), one (0.4%, 1/260) in colpocleisis, and one (0.7%, 1/150) in apical suspension for fornix prolapse. An additional 4 cases of bladder injury were referred to our hospital after aTVM. Among the 8 cases of bladder injury during aTVM, 2 cases were intraoperative incidents. Cystoscopy confirmed that the superficial branch or puncture rod of anterior vaginal mesh had penetrated into the bladder. Re-puncturing and placement of the mesh were successfully performed. No abnormalities were observed during a follow-up period of 4-5 years. Postoperative bladder injuries were identified in 6 cases, characterized by mesh erosion into the bladder and formation of calculi. These injuries were confirmed between 6 months to 2 years after vRPS. The exposed mesh and calculi in the bladder were removed through laparotomy or cystoscopy, followed up for 2-12 years. One case experienced slight re-erosion of mesh to the bladder. Conclusions: Lower urinary tract injuries are difficult to avoid in vRPS, particularly in transvaginal high uterosacral ligament suspension and aTVM. However, the incidence is low. Lower urinary tract injuries during vRPS could be easily detected and managed intraoperatively because of the use of cystoscopy. As long-term postoperative complications, erosion of transvaginal mesh to lower urinary tract postoperatively could be treated correctly, seldom with severe sequelae.

(141) Surgical Outcomes of Infrapubic Insertion of the Inflatable Penile Prosthesis in 175 Transmen After Phalloplasty

Abstract Introduction Historically, inflatable penile prostheses (IPP) insertion in a neophallus has an estimated 40-50% surgical revision rate. Objective To review the surgical outcomes of a single center’s experience with the infrapubic approach to insertion of the IPP after phalloplasty in transmen. Methods The infrapubic prosthesis insertion after phalloplasty (IPIP) technique involves a horizontal incision anterior to the pubic symphysis, which allows dissection of the neophallus channel, the Space of Retzius, and the scrotal pocket. Surgical outcomes using the Titan (Coloplast, Minneapolis, MN) IPP by a single surgeon (MLC) were analyzed between October 2017 and June 2023. Complications were reviewed and categorized into erosions, infections, device malposition and malfunction, and less common events like necrosis and urinary tract injury. Results The IPIP technique was performed on 175 phalloplasty patients by a single surgeon (MLC): 156 patients had a prior RF phalloplasty, and 19 had a prior ALT phalloplasty. The mean followup was 32.8 months. Surgical revision was required in 35 patients (20%). There were 10 pump erosions through the neoscrotum, 1 glans erosion, 9 infections, 6 pump malpositions in the neoscrotum, 6 cylinder malposition in the neophallus, 3 mechanical malfunctions with broken tubing, 2 urethral injuries, 2 bladder injuries, and 1 glans necrosis. There were no instances of implant detachment from the pubic bone anchor site, osteomyelitis, nor total phallus loss. Conclusions Data for the IPIP technique using the commercially available Coloplast Titan IPP suggest a reduction in neophallus prosthetic surgical revision rates compared to previous reports. Longer term studies with patient reported outcomes are required for further evaluation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

Identification of uromodulin deposition in the stroma of perinephric fibromyxoid nephrogenic adenoma by mass spectrometry.

Nephrogenic adenoma (NA) is an epithelial lesion that usually occurs in the mucosa of the urinary tract. Rare cases of deep infiltrative or perinephric lesions have also been reported. Recently, NA with characteristic fibromyxoid stroma (fibromyxoid NA) has been proposed as a distinct variant. Although shedding of distal renal tubular cells due to urinary tract rupture has been postulated as the cause of NA in general, the mechanism underlying extraurinary presentation of NA and fibromyxoid stromal change in fibromyxoid NA remains unknown. In this study, we performed mass spectrometry (MS) analysis in a case of perinephric fibromyxoid NA of an 82-year-old man who underwent right nephroureterectomy for distal ureteral cancer. The patient had no prior history of urinary tract injury or radiation. Periodic acid-Schiff staining-positive eosinophilic structureless deposits in the stroma of fibromyxoid NA were microdissected and subjected to liquid chromatography/MS. The analysis revealed the presence of a substantial amount of uromodulin (Tamm-Horsfall protein). The presence of urinary content in the stroma of perinephric fibromyxoid NA suggests that urinary tract rupture and engraftment of renal tubular epithelial cells directly cause the lesion.

Use of Cystoinflation to Prevent Urinary Tract Injuries in Patients with Placenta Previa

Introduction: There is insufficient evidence to support the use of cystoinflation to prevent bladder injury in women with placenta previa. The purpose of this study is to find the effectiveness and safety of cystoinflation to prevent bladder injury in women with placenta previa. Methods: The study was conducted at Gynecology &amp; Obstetrics Department, lady Willing-don hospital, Lahore for six months duration . The research was conducted by forming two groups. Women in Group-A (inflated urinary bladder) had significantly lower bladder injury as compared to women in Group-B (deflated urinary bladder). i.e. 1.9% vs. 11.32%, p-value=0.050. Results: Homeostatic sutures requirement was significantly higher in Group-B as that of Group-A. i.e. 15.1% vs. 18.9%, p-value=0.604 Duration of hospital stay showed no significant difference between groups. i.e. 96.2% patients in Group-A and 88.7% patients in Group-B discharged from hospital within 3-4 days. Conclusion: Based on the results of this study, women presenting with placenta previa had significantly lower incidences of bladder injury as a result of cystoinflation during cesarean section.

Urological injuries following gynecologic surgery: clinical manifestations, diagnosis and management

Iatrogenic urinary tract injury constitutes a rare but serious complication of gynecologic surgery, occurring in 0.3% to 1.5% of all procedures. Delayed diagnosis and repair are associated with increased postoperative morbidity, mortality and a long-term negative impact on the quality of life. Intraoperative detection of urinary tract injuries allows for prompt repair, facilitates management and speeds up recovery. Bladder injuries are 3 times more common than ureteral injuries, and usually are recognized and repaired immediately with minimal complications. Undetected ureteral injuries lead to severe postoperative complications such as the formation of genitourinary fistulas, sepsis, renal loss and death. In this review we aim to describe the postoperative clinical manifestations, the diagnostic methods and therapeutic strategies for the management of urinary tract injuries, whether in the acute or delayed setting, in an effort to reduce the potential impact of subsequent complications to both patient and surgeon. Timely and effective repair of urinary tract injuries is critical to improve patient outcome, mitigate litigation risk, and allow an uneventful postoperative recovery in a careful manner.