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Journal of Medicine and Life 2021Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed...
Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed to evaluate an important number of procedures, the complications of ureteral stents, and their prevention and treatment retrospectively. We evaluate 50,000 procedures performed between 1996 and 2021 on 36,688 patients. According to the stenting duration, the cases were divided into short-term (less than 6 weeks - 34,213 procedures), respectively long-term stenting (more than 6 weeks - 15,757 procedures). The indications of stenting for both groups were noted. The total number of complications was 41,369. We encountered 153 cases (0.3%) of JJ stent malposition, of which 3 cases were into the retroperitoneum, one case with parenchymal perforation and hematoma. Considering the double J migrations, we found proximal migration in 427 cases (0.9%) and distal double J migrations in 352 (0.7%) cases. The obstruction of the ureteral stent, causing inefficient drainage, was encountered in 925 cases, while irritative bladder symptoms occurred in 16,326 cases (32.7%). Hematuria was observed in 5,213 cases, in 7 cases blood transfusion being necessary. Urinary tract infection was diagnosed in 7,436 cases (14.8%). Stent encrustation and calcification occurred in 832 cases, while stent fragmentation was noted in 52 cases. Double J stent complications should be promptly evaluated and treated. Encrustation and stone formation in forgotten stents often lead to serious complications and should be managed with stent removal and combined endourological techniques.
Topics: Device Removal; Humans; Retrospective Studies; Stents; Ureter
PubMed: 35126746
DOI: 10.25122/jml-2021-0352 -
Annals of the Royal College of Surgeons... Nov 2022We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous...
We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous appendicitis. The patient was catheterised pre- procedure and the ports were inserted under vision. Upon completion of the procedure, a 15 Fr Robinson drain was left in the pelvis and was fed through the suprapubic port hole. Postoperatively the patient developed worsening, generalised abdominal pain and high output from the drain. The patient was re-catheterised but the computed tomography (CT) cystogram did not show any injury to the bladder. The drain fluid creatinine was noted to be raised (>4,000), indicating that urine was leaking into the drain. Conventional cystogram confirmed a contrast leak from the dome around the drain. Flexible cystoscopy confirmed that the drain had transversed the vesicourachal diverticula. The drain was pulled back and converted to a suprapubic catheter with the patient subsequently being discharged. Vesicourachal diverticula is a rare and often asymptomatic anomaly. When undertaking laparoscopic surgery, precautions should be taken to prevent port site injury such as catheterising the patient to ensure the bladder is empty and inserting the ports under direct vision. It is safer to visualise muscle rather than peritoneum during port insertion. In this case, the bladder diverticula was noticed extraperitoneally. Though the indirect CT cystogram reported no injury, this was unreliable as the bladder was not distended which led to the subtle injury being missed. Traditional cystogram should be considered in cases with a negative CT cystogram and a strong suspicion of bladder injury.
Topics: Male; Humans; Middle Aged; Urinary Bladder; Diverticulum; Urinary Bladder Diseases; Cystoscopy
PubMed: 35446699
DOI: 10.1308/rcsann.2021.0344 -
Cureus Oct 2021Placenta percreta is the most severe form of placenta accreta and is characterized by placental invasion through the entirety of the myometrium and possibly into...
Placenta percreta is the most severe form of placenta accreta and is characterized by placental invasion through the entirety of the myometrium and possibly into extrauterine tissues. It is associated with prior cesarean deliveries and placenta previa. Herein, we present the case of a patient who developed placenta percreta and experienced massive blood loss of 27 liters. She developed many complications over the next 11 months, including deep vein thrombosis, pulmonary embolism, preeclampsia after pregnancy, hematoma, blood clots in the bladder, lactation failure, ileus, vesicovaginal fistula, excessive scar tissue requiring surgery, loss of an ovary, and recurrent bladder perforation. We analyze the mechanisms of these complications and the most common complications associated with placenta percreta.
PubMed: 34804697
DOI: 10.7759/cureus.18842 -
Minerva Urology and Nephrology Oct 2022Despite bladder perforation (BP) is a frequent complication during transurethral resection of bladder (TURB) for bladder cancer (BCa), literature lacks systematic... (Review)
Review
INTRODUCTION
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).
EVIDENCE ACQUISITION
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.
EVIDENCE SYNTHESIS
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.
CONCLUSIONS
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.
Topics: Abdominal Injuries; Algorithms; Follow-Up Studies; Humans; Neoplasm Recurrence, Local; Systematic Reviews as Topic; Urinary Bladder; Urinary Bladder Diseases
PubMed: 34263743
DOI: 10.23736/S2724-6051.21.04436-0 -
International Journal of Surgery Case... Apr 2021Spontaneous urinary bladder rupture is a rare complication of urosepsis. Its co-occurrence with pneumoperitoneum is even more unusual.
INTRODUCTION AND IMPORTANCE
Spontaneous urinary bladder rupture is a rare complication of urosepsis. Its co-occurrence with pneumoperitoneum is even more unusual.
CASE PRESENTATION
A 73-year-old patient presented with acute retention with mild lower abdominal pain and difficulty with urinary voiding and cystitis. He was treated with bladder catheter and antibiotics. After one month, he suddenly developed peritonitis and shock. Pneumoperitoneum was observed on a chest x-ray. An emergent laparotomy was performed and a perforation of the bladder secondary to necrosis of part of the wall was found and resected. The patient recovered satisfactorily after the surgical intervention.
CLINICAL DISCUSSION
Spontaneous bladder rupture is a life-threatening condition that could be missed. Surgical intervention is mandatory to rule out other more probable causes of peritonitis and to manage the bladder perforation itself.
CONCLUSION
Pneumoperitoneum is rarely secondary to a bladder perforation. Immediate surgical intervention is required in order to avoid delays in treating any intra-abdominal condition including a bladder wall perforation.
PubMed: 33744799
DOI: 10.1016/j.ijscr.2021.105783 -
Discover Oncology Jan 2023Urinary neoplasms refer to malignant tumours occurring in any part of the urinary system, including the kidney, renal pelvis, ureter, bladder, prostate, etc. The... (Review)
Review
Urinary neoplasms refer to malignant tumours occurring in any part of the urinary system, including the kidney, renal pelvis, ureter, bladder, prostate, etc. The worldwide incidence of urinary system tumours has been increasing yearly. Available methods include surgical treatment, radiotherapy, chemotherapy, endocrine therapy, molecular targeted therapy, and immune therapy. In recent years, emerging evidence has demonstrated that cell pyroptosis plays an important role in the occurrence and progression of malignant urinary tumours. Pyroptosis is a new type of cell death that involves inflammatory processes regulated by gasdermins (GSDMs) and is characterized by membrane perforation, cell swelling and cell rupture. Recent studies have shown that pyroptosis can inhibit and promote the development of tumours. This manuscript reviews the role of pyroptosis in the development and progression of prostate cancer, kidney cancer and bladder cancer and introduces the latest research results in these fields to discuss the therapeutic potential of the pyroptosis pathway in urinary malignancies.
PubMed: 36702978
DOI: 10.1007/s12672-023-00620-7 -
International Urology and Nephrology Sep 2023To report the incidence, predictors, the impact of bladder perforation (BP), and our protocol of management in patients who underwent trans-urethral resection of bladder...
Bladder perforation as a complication of transurethral resection of bladder tumors: the predictors, management, and its impact in a series of 1570 at a tertiary urology institute.
OBJECTIVES
To report the incidence, predictors, the impact of bladder perforation (BP), and our protocol of management in patients who underwent trans-urethral resection of bladder tumor (TURBT).
METHODS
This is a retrospective study, between 2006 and 2020, on patients who underwent TURBT for non-muscle-invasive bladder cancer (NMIBC). Bladder perforation was defined as any full thickness resection of the bladder wall. Bladder perforations were managed based on their severity and type. Small BP with no or mild symptoms were managed with prolongation of urethral catheters. Those with significant extraperitoneal extravasations were managed by insertion of a tube drain (TD). Abdominal exploration was done for extensive BP and all intraperitoneal extravasations.
RESULTS
Our study included 1,570 patients, the mean age was 58 ± 11 years and 86% were males. Bladder perforation was recorded in 10% (n = 158) of the patients. The perforation was extraperitoneal in 95%, and in 86%, the perforation was associated with no symptoms, mild symptoms, or mild fluid extravasation that required only prolongation of the urethral catheter. On the other hand, active intervention was required for the 21 remaining patients (14%) with TD being the most frequent management. History of previous TURBT (p = 0.001) and obturator jerk (p = 0.0001) were the only predictors for BP.
CONCLUSIONS
The overall incidence of bladder perforation is 10%; however, 86% required only prolongation of urethral catheter. Bladder perforation did not affect the probability for tumor recurrence, tumor progression nor radical cystectomy.
Topics: Male; Humans; Middle Aged; Aged; Female; Urinary Bladder; Urology; Retrospective Studies; Transurethral Resection of Bladder; Neoplasm Recurrence, Local; Urinary Bladder Neoplasms; Cystectomy; Neoplasm Invasiveness
PubMed: 37318699
DOI: 10.1007/s11255-023-03638-6 -
International Braz J Urol : Official... 2017Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates,... (Review)
Review
Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.
Topics: Female; Humans; Postoperative Complications; Suburethral Slings; Urinary Incontinence, Stress; Urologic Surgical Procedures
PubMed: 28266818
DOI: 10.1590/S1677-5538.IBJU.2016.0250 -
Cureus Dec 2022Urinary bladder perforation is one of the few surgical emergencies prone to misdiagnosis, leading to a high mortality rate. Our case highlights patient management in...
Urinary bladder perforation is one of the few surgical emergencies prone to misdiagnosis, leading to a high mortality rate. Our case highlights patient management in such cases and reviews similar reports to increase awareness about patients with indwelling catheters and suspicion of bladder perforation. A 73-year-old patient with decompensated heart failure developed severe abdominal pain, abdominal distention, and hematuria following a Foley catheter insertion. Computed tomography (CT) raised suspicion of bladder perforation. Exploratory laparotomy revealed serosanguinous fluid in the abdomen and rupture of the bladder dome. Bladder repair was performed, and the patient was monitored post-operatively under intensive care, with an uneventful recovery before discharge. There are many causes of bladder perforation. It occurs most commonly due to traumatic incidence, iatrogenic instrumentation, or spontaneous rupture. It is a rare complication, accounting for 0.002% of all hospital admissions. According to the Centers for Disease Control (CDC), 12-15% of patients receive a urinary catheter during their hospital stay; therefore, it is important to consider complications of catheterization and their management. Bladder rupture can present with non-specific symptoms leading to delayed management. We recommend clinical attention to patients with urinary catheter insertion presenting with severe abdominal pain, difficulty voiding, or hematuria to rule out the possibility of perforation. Rapid diagnosis and accurate treatment of such cases are crucial for an uneventful recovery.
PubMed: 36582418
DOI: 10.7759/cureus.32887 -
Journal of Indian Association of... 2017Bladder augmentation is an important part of pediatric reconstructive urology. This study was conducted to assess the feasibility and results of our technique of...
INTRODUCTION
Bladder augmentation is an important part of pediatric reconstructive urology. This study was conducted to assess the feasibility and results of our technique of preperitoneal bladder augmentation.
MATERIALS AND METHODS
Thirty-three children underwent preperitoneal bladder augmentation for small inelastic bladders who had failed medical management or needed undiversion. The underlying diagnosis included neurogenic bladder, valve bladder, bladder exstrophy, non-neurogenic neurogenic, ectopic ureters, and urogenital sinus. The operative procedure involved placing the entire augmentation in the preperitoneal or subcutaneous space after bivalving the native bladder. The augment segment of the bowel with its pedicle was brought into the preperitoneal space through a small opening in the parietal peritoneum. A Mitrofanoff port was also provided where needed.
RESULTS
Preperitoneal augmentation provided an adequately compliant, good volume bladder except in children with bladder exstrophy or previous abdominal surgery. There was a good cystometric recovery, with resolution of hydronephrosis and incontinence. Vesicoureteral reflux resolved in 24 of 26 units. In the 13 children who were uremic preoperatively, there was a significant decrease in serum creatinine levels, although 9 children continued to have supra-normal serum creatinine. Surgical complications seen were within expectations. There was no incidence of intraperitoneal leak, which is the main projected benefit of this procedure over the traditional "intraperitoneal" method of augmentation.
CONCLUSIONS
The preperitoneal augmentation provides an adequate, safe, and low-pressure reservoir of urine except in cases of bladder exstrophy and previous abdominal surgery.
PubMed: 28974870
DOI: 10.4103/0971-9261.214443