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Journal of Pediatric Urology Aug 2017Three complications have been hypothesized to increase patient mortality following enterocystoplasty: spontaneous bladder perforation, bladder neoplasia, and chronic... (Review)
Review
INTRODUCTION
Three complications have been hypothesized to increase patient mortality following enterocystoplasty: spontaneous bladder perforation, bladder neoplasia, and chronic renal failure (CRF). The present study examined risk of their occurrence and discussed ways to improve the quality of care.
MATERIALS AND METHODS
The present transitional clinic followed 385 patients with a history of bladder augmentation using either ileal, sigmoid, or ascending colon. The median age was 37 years (range 16-71). Median follow-up interval after augmentation was 26 years (range 2-59).
DISCUSSION
Spontaneous rupture of the bladder occurred in 3% (13/385), with one associated death (0.25%, 1/385). Spontaneous bladder rupture significantly correlated with substance abuse, non-compliance with catheterization, and mental/physical disabilities that required the use of surrogates to perform and monitor intermittent catheterization (P < 0.01). Of the 203 patients that were followed for ≥10 years, 4% (8/203) developed a bladder tumor. In comparison, 2.5% (5/203) of an age-matched control population, managed by anticholinergics and intermittent catheterization, developed a bladder tumor. Therefore, enterocystoplasty cannot be associated with an increased risk of cancer development (P = 0.397). Chronic renal failure ≥ Stage 3 arose in 15% (58/385), and 1% (4/385) of the patients died as a result of this complication. Obese patients (BMI ≥30) catheterizing per urethra were more likely to be non-compliant with catheterization and develop CRF compared with obese patients with a continent catheterizable stoma (P > 0.001). These findings suggest that compliance with intermittent catheterization and renal preservation are enhanced by the presence of a catheterizable abdominal stoma.
CONCLUSION
The individual's intellectual and physical capability to obey medical directives, refrain from high-risk habits, maintain a healthy weight, and comply with long-term follow-up visits were all critical to the enduring success of bladder augmentation.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Patient Compliance; Postoperative Complications; Retrospective Studies; Risk Factors; Survival Rate; Urinary Bladder Diseases; Urinary Diversion; Young Adult
PubMed: 28645552
DOI: 10.1016/j.jpurol.2017.05.008 -
World Journal of Surgical Oncology Aug 2020Transurethral resection of the bladder tumour (TUR) is associated with a risk of bladder perforation. The underlying mechanisms and risk factors are not fully...
BACKGROUND
Transurethral resection of the bladder tumour (TUR) is associated with a risk of bladder perforation. The underlying mechanisms and risk factors are not fully understood. The aim of this study was to determine if the bladder wall structure affects the risk of bladder perforation during TUR.
METHODS
Fifteen patients who underwent TUR complicated by a bladder perforation (group 1) and fifteen matched controls who underwent uncomplicated TUR (group 2) were retrospectively enrolled in this morphological analysis. Surgical specimens were collected from all participating patients to describe the quality and architecture of urothelium and bladder submucosa. Immunohistochemical studies were performed with primary mouse anti-human E-cadherin, beta-catenin, type IV collagen, cytokeratin 20 and epithelial membrane antigen antibodies. The intensity of the immunohistochemical reaction was assessed using an immunoreactive score (IRS). Ultrastructural examinations were performed by transmission electron microscopy. The microscopic assessment was focused on the intensity of fibrosis in the bladder submucosa and the presence of degenerative changes in the urothelium.
RESULTS
Patients' age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. The immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From a clinical point of view, ultrastructural analysis by electron microscopy showed a higher rate of severe fibrosis in group 1 (63.6% vs. 38.5%), with no differences in the rate and degree of urothelial changes. However, these differences were not statistically significant (p = 0.32).
CONCLUSIONS
Bladder perforation during TUR is not a result of a deficient structure of the bladder wall. Based on available evidence, the surgical technique seems to play the most important role in its prevention.
Topics: Animals; Humans; Mice; Prognosis; Retrospective Studies; Urinary Bladder Neoplasms; Urothelium
PubMed: 32814580
DOI: 10.1186/s12957-020-01992-8 -
Cureus Jan 2021Acute uncomplicated appendicitis is a common surgical disease that has been well-studied, and its overall mortality has decreased over time. However, delay in treatment...
Acute uncomplicated appendicitis is a common surgical disease that has been well-studied, and its overall mortality has decreased over time. However, delay in treatment can be associated with rare complications such as necrotizing fasciitis, which carries a high mortality rate, and bladder perforation. We present such a case in an 81-year-old female with no significant surgical history who presented to the emergency department with four days of abdominal pain. A CT scan revealed extensive subcutaneous air in the abdominal wall, an inflamed appendix, and a periappendiceal abscess. During subsequent exploratory laparotomy, she was also found to have bladder perforation. She underwent debridement of necrotic tissue of the abdominal wall, appendectomy, drainage of periappendiceal abscess, and bladder perforation repair. She died of septic shock on post-operative day 19, due to gross spillage of urine into the abdomen and ongoing necrotizing fasciitis. Acute perforated appendicitis can lead to rare and fatal complications. Our case presents such a patient with a poor outcome. In approaching a patient with signs of peritonitis, differential diagnoses must remain broad to include late complications such as abscess formation, soft tissue infection, and perforation of surrounding structures.
PubMed: 33489640
DOI: 10.7759/cureus.12764 -
Maedica Dec 2020Intrauterine devices (IUD) are one of the most commonly used methods of contraception worldwide. The long term effect makes it desirable by most patients. The insertion...
Intrauterine devices (IUD) are one of the most commonly used methods of contraception worldwide. The long term effect makes it desirable by most patients. The insertion of an IUD is not difficult as a technique but it involves multiple complications such as uterine perforation and migration into the abdominal cavity, urinary bladder perforation, fistula formation, bowel perforation and intra-abdominal adhesions. We present the case of a 31-year-old female patient (para=4) with a medical history of an IUD insertion during her postpartum period in February 2018. In April 2019, during her normal follow up consultation, the speculum examination did not detect any IUD strings and the abdominopelvic ultrasound showed no signs of the device inside the uterine cavity. A subsequent X-ray identified the device in a horizontal position in the pelvic region. The patient was scheduled for surgical intervention, but in the meantime she became pregnant. Decision to continue with the pregnancy was taken and surgery was delayed until the postpartum period. In August 2020, a laparoscopic surgical procedure was performed; during the intervention, the IUD was identified in the anterior rectal wall with only the strings exiting the wall. Therefore, a visceral surgeon advice was required. The device was removed by continuing the laparoscopic intervention. The patient was given antibiotic treatment and had a favorable evolution. Although IUD is thought to be an easy and accessible method of contraception, complications such as uterine perforation must always be taken in consideration and well explained to all patients.
PubMed: 33603916
DOI: 10.26574/maedica.2020.15.4.549 -
European Journal of Case Reports in... 2024Rectus sheath haematoma (RSH) has become increasingly common but is often underdiagnosed. Prompt diagnosis will avoid unnecessary investigations and procedures,...
INTRODUCTION
Rectus sheath haematoma (RSH) has become increasingly common but is often underdiagnosed. Prompt diagnosis will avoid unnecessary investigations and procedures, resulting in early treatment and a better outcome.
CASE DESCRIPTION
We described a case of a spontaneous RSH with intraperitoneal extension and formation of a vesico-haematoma fistula, which was initially misdiagnosed as a urinary tract infection. The diagnosis was made ten days after admission, when a CT scan showed an over-16 cm RSH with intraperitoneal extension, bladder perforation and a vesico-haematoma fistula. The patient was managed conservatively.
DISCUSSION
RSH accounts for less than 2% of acute abdomen cases and is often unrecognised. Its presentation can mimic other intra-abdominal pathologies, and the diagnosis is often delayed or missed. Complications can arise from an RSH although it is generally viewed as a self-limiting condition.
CONCLUSION
RSH has become increasingly common, and we would like to highlight the need to include abdominal wall pathologies in the initial differential diagnoses of acute abdomen to avoid delay in diagnosis.
LEARNING POINTS
Rectus sheath haematoma has become increasingly common due to the use of anticoagulants.The presentation can be non-specific and mimic other intra-abdominal pathologies. Misdiagnosis or delayed diagnosis can result in complications and unnecessary invasive procedures.Abdominal wall pathologies including rectus sheath haematomas should be included in initial differentials of acute abdomen.
PubMed: 38584897
DOI: 10.12890/2024_004362 -
Facts, Views & Vision in ObGyn May 2020Resectoscopic injuries to bowel and/or vessels, although rare, can be catastrophic, resulting in significant patient harm including death and can provoke medicolegal...
BACKGROUND
Resectoscopic injuries to bowel and/or vessels, although rare, can be catastrophic, resulting in significant patient harm including death and can provoke medicolegal litigation.
OBJECTIVE
To examine indications, preoperative risk factors, perioperative findings and intervention, and clinical outcomes of resectoscopic injuries.
MATERIALS AND METHODS
Eleven cases of resectoscopic complications were reviewed by one author (G.A.V.) for medicolegal purposes. After grouping of the complications, one case for each complication was selected, edited and reconstructed to reflect and highlight all potential complications associated with monopolar resectoscopes (26F, 9-mm) and nonconductive distending medium. Although these cases are reconstructed from actual complications, they do not reflect specific cases of medicolegal opinions and outcomes. Indications for resectoscopic surgery included abnormal uterine bleeding and/or infertility in premenopausal women.
RESULTS
Injuries were associated with uterine perforation resulting in hemorrhage or bowel injury; urinary bladder injury without uterine perforation; and thermal injuries to lower genital tract and dispersive electrode site.
CONCLUSIONS
Resectoscopic complications are associated with any one or a combination of trauma during uterine access or intra-operatively, excessive fluid intravasation of distending medium or thermal injuries from applied energy. Uterine perforation in the presence of distorted anatomy (e.g. uterine fibroids) may be considered as a known and accepted complication. Lower genital tract and dispersive electrode site burn occur due to inherent design of monopolar resectoscopes. Appropriate intra- and post-operative intervention minimizes adverse clinical and medicolegal outcomes. Lack of post-operative vigilance and inappropriate delay in investigation and intervention is associated with adverse clinical and, potentially, unfavourable legal outcomes.
WHAT IS NEW?
Reviewing resectoscopic complications raises awareness; provides insight for avoidance, recognition and timely intervention to minimise adverse clinical and medicolegal outcomes.
PubMed: 32696024
DOI: No ID Found -
Der Urologe. Ausg. A Jan 2022Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation...
Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guérin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract.
Topics: Administration, Intravesical; BCG Vaccine; Cystectomy; Humans; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 34982181
DOI: 10.1007/s00120-021-01741-z -
World Journal of Surgical Oncology Sep 2014Transurethral laser therapy techniques are increasingly being used in the management of bladder tumors. It has reportedly been associated with good outcomes in small... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transurethral laser therapy techniques are increasingly being used in the management of bladder tumors. It has reportedly been associated with good outcomes in small case series. The objective of the present study was to review the published literature and compare transurethral laser therapy for non-muscle-invasive bladder cancer (NMIBC) and conventional transurethral resection of bladder tumor (TURBT).
METHODS
We performed a systematic review and meta-analysis based on randomized controlled trials (RCTs) and controlled clinical trials (CCTs) to assess the two techniques. The eligible RCTs and CCTs were identified in the following electronic databases: PubMed, the Cochrane Central Register of Controlled Trials and Embase.
RESULTS
Seven studies were included in this systematic review. The baseline characteristics of these studies are comparable. We found no statistical difference between the two techniques regarding operative time. The intra- and postoperative complications showed that the laser procedure was better than TURBT for NMIBC, including obturator nerve reflex, bladder perforation, bladder irrigation rate, duration of catheterization and length of hospital stay. In addition, the 2-year recurrence-free survival improved in the laser group than in the TURBT group.
CONCLUSIONS
Our systematic review and meta-analysis suggests that laser techniques are feasible, safe, effective procedures that provide an alternative treatment for patients with NMIBC. Given that some limitations cannot be overcome, well-designed RCTs are needed to confirm our findings.
Topics: Humans; Laser Therapy; Prognosis; Safety; Urinary Bladder Neoplasms
PubMed: 25256383
DOI: 10.1186/1477-7819-12-301 -
Annals of Coloproctology Jul 2021Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and...
Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.
PubMed: 32178494
DOI: 10.3393/ac.2019.01.18 -
Urologia Internationalis 2022We investigated the efficacy of a urethral catheter alone for intraperitoneal perforation during transurethral resection of bladder tumor (TURBT).
Efficacy of the Treatment of Intraperitoneal Bladder Perforation during Transurethral Resection of Bladder Tumor with the Urethral Catheter Alone: Retrospective Analysis of over 15 Years Using the Clinical Data Warehouse System.
INTRODUCTION
We investigated the efficacy of a urethral catheter alone for intraperitoneal perforation during transurethral resection of bladder tumor (TURBT).
PATIENTS AND METHODS
We retrospectively evaluated the medical records of 4,543 patients who underwent TURBT from January 2000 to December 2017 using the Clinical Data Warehouse system. The clinicopathologic characteristics, recurrence-free survival, and progression-free survival were compared between the patient groups with intraperitoneal perforation treated with the Foley catheter alone, extraperitoneal perforation, and matched control TURBT.
RESULTS
Intraperitoneal perforation and extraperitoneal perforation were observed in 16 (35.6%) and 29 (64.4%) patients, respectively. In the intraperitoneal perforation group, 11 (68.8%), 2 (12.5%), and 3 (18.8%) patients were treated with the Foley catheter alone, additional percutaneous drainage, and delayed open surgery, respectively. The use of the Foley catheter alone in patients with intraperitoneal perforation of smaller size than the cystoscope or no pelvic radiotherapy history showed improved efficacy without sequelae or therapeutic delay. One of the 2 patients with the size of the intraperitoneal perforation larger than the cystoscope was successfully treated with the Foley catheter alone, whereas the other patient underwent delayed surgical repair. There was no difference in recurrence-free survival and progression-free survival of the intraperitoneal perforation treated with the Foley catheter alone compared to those of the matched control TURBT (p = 0.909, p = 0.518) and the extraperitoneal perforation (p = 0.458, p = 0.699).
CONCLUSIONS
Intraperitoneal perforation rarely occurred during TURBT. In the case of intraperitoneal perforation of size smaller than cystoscopy or without pelvic radiotherapy history, treatment with the Foley alone showed successful improvement and safe oncological results. Therefore, treatment with the urethral catheter alone can be carefully considered when an intraperitoneal perforation smaller than the cystoscope size or without pelvic radiotherapy history occurs.
Topics: Aged; Aged, 80 and over; Cystectomy; Female; Humans; Intraoperative Complications; Male; Middle Aged; Peritoneum; Retrospective Studies; Time Factors; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms; Urinary Catheterization
PubMed: 34350882
DOI: 10.1159/000517332