Urological injuries
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Infections are common in women of all ages starting from young girls to newly married [HONEYMOON CYSTITIS] to elderly postmenopausal women. In each group the cause may be different and requires thorough examination. Some women also suffer from TUBERCULOSIS of urinary tract.
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Urological injuries
- 2. INTRODUCTION • URINARY TRACT INJURIES ARE NOT UNCOMMON • INCREASED INCIDENCE WITH LAPAROSCOPIC SURGERIES • DEVASTATING TO THE PATIENT
- 3. UROLOGICAL INJURIES • BLADDER INJURY • URETERIC INJURIES • EITHER DURING CAESAREAN OR HYSTERECTOMY
- 4. CLINICAL PRESENTATION • DEPENDS ON THE TIME OF DETECTION • EARLY POST-OP • BLADDER – HEMATURIA • URETER – LOIN PAIN, FEVER, ABDOMINAL DISTENSION • ANURIA – RARE- BILATERAL URETERS
- 5. URINARY FISTULAE • MOST DEVASTATING CONSEQUENCE • INJURY UNDETECTED INTRAOP OR EARLY POSTOP • OR • FAILED PRIMARY REPAIR • OR CO-EXISTING INJURY MISSED INTRAOP
- 6. TYPES OF URINARY FISTULAE • POST HYSTERECTOMY • V V F • URETERO-VAGINAL FISTULA • POST CAESAREAN • VESICO-UTERINE FISTULA • URETERO-UTERINE FISTULA
- 7. VESICO-VAGINAL FISTULA • MOST COMMONLY SEEN FISTULA • CONTINUOUS LEAKAGE OF URINE WITHOUT NORMAL VOIDING • PARADOXICAL INCONTINENCE WITH SMALL VVF
- 8. URETERO-VAGINAL FISTULA • 0.5% FOLLOWING VAGINAL HYST. • 1% FOLLOWING OPEN ABDOMINAL HYST. • 2-3% WITH LAP HYSTERECTOMY
- 9. URETERO-VAGINAL FISTULA • PRESENTS WITH PARADOXICAL INCONTINENCE • URINE LEAK PER VAGINA WITH NORMAL VOIDING • 1 WEEK – 10 DAYS POST-OP
- 10. VESICO-UTERINE FISTULA • UNDETECTED BLADDER INJURY DURING A CAESAREAN SECTION • PRESENTS WITH URINE LEAK THRU CERVIX • CYCLICAL HEMATURIA WITHOUT ANY URINARY LEAK--
- 11. MRI PELVIS—POST CAESAREAN FISTULA BETWEEN BLADDER DOME AND UTERUS
- 13. MR MRI UROGRAM SHOWING NORMAL UPPER TRACTS WITH VESICO-UTERINE FISTULA
- 14. VESICO-UTERINE FISTULA • TREATMENT • TRANSPERITONEAL REPAIR WITH OMENTAL INTERPOSITION • HYSTERECTOMY REQUIRED IN SOME CASES
- 16. IVP TOTAL URETERIC OBST. FOLLOWING LSCS
- 18. IVP – LEFT URETERO-UTERINE FISTULA
- 19. URETERO-UTERINE FISTULA • RAREST FORM OF URINARY FISTULA • 0.02% FOLLOWING CAESAREAN • MORE COMMON ON LEFT SIDE • DUE TO DEXTRO-ROTATION • BLIND ATTEMPT AT HEMOSTASIS
- 20. URETERO-UTERINE FISTULA • CLINICAL PRESENTATION • LOIN PAIN, FEVER • URINE LEAK THRU CERVIX • NORMAL VOIDING
- 21. PREVENTION OF BLADDER INJURIES • FOCUS ON 3 AREAS • OPENING THE PERITONEUM • FULL BLADDER • PREVIOUS SURGERY • MOBILIZING THE BLADDER OFF THE UTERUS • CLOSURE OF UTERUS OR VAULT
- 22. PREVENTION OF URETERIC INJURIES • IDENTIFY HIGH RISK CASES • PID,ENDOMETRIOSIS, OVARIAN TUMORS,BROAD LIG. OR CERVICAL FIBROID • PREOP-IVP • INTRAOP STENTING • AVOID SKELETONIZING THE URETERS
- 23. DIAGNOSIS • BEST TIME TO DETECT IS DURING SURGERY • HIGH INDEX OF SUSPICION • WHEN IN DOUBT – CALL A UROLOGIST
- 24. BLADDER INJURIES • CHECK FOR INTEGRITY BY FILLING SALINE • ANY BLADDER REPAIR – POST OP INDWELLING CATHETERIZATION • DON’T HESITATE TO PUT AN SPC WHEN INJURY IS EXTENSIVE
- 25. URETERIC INJURIES • HIGH INDEX OF SUSPICION ANY DIFFICULT DISSECTION CYSTOSCOPY AND RGP UNDER FLOROSCOPY WHEN IN DOUBT, SAFER TO STENT
- 26. POST-OP URINE LEAK • WHAT NEXT? • DIAGNOSIS – TYPE OF FISTULA • HISTORY – TOTAL / PARADOXICAL • EXAM.- LEAK P/V OR PER URETHRA
- 27. DIAGNOSIS OF TYPE OF FISTULA USG - • VVF / VESICO-UTERINE FISTULA NORMAL KIDNEYS BLADDER MAY BE EMPTY • UVF / URETERO-UTERINE FISTULA HYDRONEPHROSIS
- 28. DIAGNOSIS • IVP URETERIC FISTULAE HYDRONEPHROSIS & HYDRO-URETER VVF- CYSTOGRAM PHASE URINE LEAK INTO VAGINA
- 29. DIAGNOSIS [ contd] • CYSTOSCOPY AND RGP • V V F SITE SIZE NUMBER PROXIMITY TO ORIFICES ANY INFLAMMATION RGP- EXACT SITE OF URETERIC INJURY
- 30. DIAGNOSIS CT UROGRAM / MRI • FOR POST CAESAREAN LEAKS VESICO-UTERINE FISTULA URETERO-UTERINE FISTULA
- 31. TREATMENT • VVF - CONSERVATIVE • SURGICAL OPTIONS VAGINAL ABDOMINAL – TRANSVESICAL TRANSPERITONEAL LAPAROSCOPIC
- 32. TREATMENT VESICO-UTERINE FISTULA TRANSPERITONEAL REPAIR OMENTAL INTERPOSITION MAY NEED HYSTERECTOMY
- 33. URETERIC INJURIES • TREATMENT OPTIONS BASED ON • TIME OF DETECTION • SITE OF INJURY • NATURE OF INJURY • UNILATERAL / BILAT.
- 34. URETERIC INJURIES TREATMENT OPTIONS URETEROSCOPIC STENTING END-TO-END ANAST. RE-IMPLANTATION DIRECT PSOAS-HITCH BOARI’S FLAP