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Open Access Journal of Contraception 2024Intrauterine devices (IUDs) are a widely used contraceptive. Possible complications from IUDs include failed insertion, pain, vasovagal reaction, infection, abnormal... (Review)
Review
Intrauterine devices (IUDs) are a widely used contraceptive. Possible complications from IUDs include failed insertion, pain, vasovagal reaction, infection, abnormal bleeding, and expulsion. Uterine perforation and migration of the IUD are rare complications occurring in approximately 1-2 per 1000 insertions. We executed a systematic review by reviewing all case reports and case series on IUD migration, published between December 2002 and December 2022. Our review indicates that about half of these patients present with pain and that a third are completely asymptomatic. The most common sites of migration are the intestine, bladder, and omentum. We found that the preferred method for removing the migrated IUD is laparoscopy. Generally, there are no lasting injuries after the removal of the migrated IUD, but occasionally, severe complications have been reported. Healthcare providers should be vigilant about this rare complication, especially in cases of painful insertion or the presence of other risk factors for perforation. When uterine perforation is diagnosed, it is advisable to remove the IUD to prevent severe complications.
PubMed: 38495451
DOI: 10.2147/OAJC.S458156 -
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 -
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 -
World Journal of Gastroenterology Feb 2024Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare...
Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.
Topics: Humans; Acute Disease; Pancreatitis; Spleen; Abdominal Injuries; Gastrointestinal Hemorrhage; Colonoscopy
PubMed: 38515946
DOI: 10.3748/wjg.v30.i7.624 -
Canadian Urological Association Journal... Sep 2023Urethral mesh perforation is a rare complication of mid-urethral sling resulting in a lack of clear management guidelines. Thus, we aimed to determine management options... (Review)
Review
INTRODUCTION
Urethral mesh perforation is a rare complication of mid-urethral sling resulting in a lack of clear management guidelines. Thus, we aimed to determine management options and their respective outcomes in terms of erosion resolution and continence.
METHODS
A literature review was performed by extracting studies from the PubMed, Cochrane, and Google Scholar from January 1996 to December 1, 2022. Only French and English language studies were included. A total of 227 papers were screened and assessed for eligibility.
RESULTS
Forty-eight studies were included in the final analysis, for a total of 224 patients. Treatment options consisted of conservative, endoscopic, transurethral, and transvaginal approaches. Conservative treatment was associated with a 100% risk of persistence or recurrence of urethral perforation, while the failure rates for endoscopic, transurethral, and transvaginal approaches were 33%, 7.5%, and 7%, respectively. Most patients suffered from stress urinary incontinence after reconstructive management. The most common symptoms at the time of presentation were overactive bladder and pain. The mean time between the onset of symptoms and diagnosis was 10 months. About half of the urethral mesh perforations were diagnosed within the first years after the initial sling insertion.
CONCLUSIONS
Multiple management options for sling penetration of the urethra have been described in the literature. Transvaginal sling resection with consecutive tissue interposition seems to carry the lowest risk of erosion recurrence; however, all treatment options are associated with a high relapse rate for stress urinary incontinence.
PubMed: 37458745
DOI: 10.5489/cuaj.8293 -
BJUI Compass Jan 2024To characterise cases of spontaneous rupture of the urinary bladder in the context of bladder cancer. (Review)
Review
OBJECTIVES
To characterise cases of spontaneous rupture of the urinary bladder in the context of bladder cancer.
METHODS
A systematic review was performed to characterise cases of spontaneous bladder rupture in patients with bladder cancer. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system was utilised, with databases being searched for relevant cases. Patient characteristics were extracted, including age, sex, presenting signs and symptoms, management modalities, tumour histology and mortality.
RESULTS
Thirty cases were included. Seventeen (57%) were male, and the median age of presentation was 59. Abdominal pain and peritonism were the most common presenting symptoms, in 80% and 60% of patients, respectively. Most patients ( = 16, 53%) had urothelial cell carcinoma. Nine patients (30%) died during their initial hospitalisation.
CONCLUSION
Spontaneous bladder perforation in the context of bladder cancer is a rare cause of acute abdomen. The diagnosis is associated with high mortality, highlighting the aggressive nature of the malignancies that cause spontaneous bladder rupture. This raises important questions about the role of emergency cystectomy, the timing of systemic therapy and the appropriate involvement of palliative care.
PubMed: 38179032
DOI: 10.1002/bco2.281