Objectives: Iatrogenic ureteral injury is a severe surgical complication, with a highest incidence of 1.5% in gynecological surgeries. The purpose of this report is to document our initial experience with using methylene blue (MB) to label the ureter in gynecological laparoscopic surgeries and to explore its effectiveness and safety. This is also a novel description of simultaneously visualizing ureteral MB fluorescence and sentinel lymph nodes (SLN's) Indocyanine Green (ICG) fluorescence using the same camera.
Methods: This study included patients undergoing gynecological laparoscopic surgeries, with the same surgeon performing all cases. During the early stages of each surgery, rapid intravenous infusion of MB was administered. For cases requiring SLN imaging, we also injected ICG solution into the cervix. Assessment of the included cases was conducted both intraoperatively and postoperatively. The group that had MB fluorescence (Group A) was compared to a control group that did not have it (Group B).
Results: A total of 25 patients (Group A) received MB during surgery, demonstrating 45 ureters clearly, with an imaging success rate of 90%. Continuous and clearer fluorescence imaging was achieved in cases with ureteral hydronephrosis. In most patients, ureteral fluorescence was visible 15-20 min after intravenous infusion of MB, and 64% still exhibited fluorescence at the end of the surgery. In patients who had both ICG and MB, dual fluorescence imaging was achieved clearly. Among the included cases, there were no iatrogenic ureteral injuries (0%), which we observed to be lower than in patients who did not receive MB (1.3%). The rate of adverse events was similar in both groups.
Conclusion: Using MB fluorescence is an effective and safe method of visualizing the ureters during gynecological surgeries, and can diminish iatrogenic ureteral injury without increased associated adverse events. It therefore may offer promising prospects for clinical application.
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http://dx.doi.org/10.3389/fsurg.2024.1387038 | DOI Listing |
Urol Ann
October 2024
Department of Surgery, Division of Urology, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
Objectives: As iatrogenic ureteral injury carries a high burden and is associated with increased postoperative morbidity and mortality, the purpose of this study is to determine the incidence and potential risk factors of iatrogenic ureteral injury following common obstetric and gynecological surgeries in King Abdulaziz Medical City.
Methods: This was a single-center retrospective cohort study based on data extracted from an electronic hospital information system conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Three thousand four hundred and sixty-four cases of cesarean section (C-section) and hysterectomy from January 1, 2021, to December 31, 2022, were reviewed.
Medicina (Kaunas)
November 2024
Division of Pediatric Surgery, Federico II University Hospital, 80131 Naples, Italy.
Urologiia
July 2024
CDC Zdorovie, Rostov-on-Don, Russia.
Introduction: Transurethral resection is the main method for diagnosing and staging bladder cancer, which allows to determine treatment tactics. Tumors located in the area of the ureteric orifice is an important clinical problem.
Aim: To describe our experience in the treatment of ureteral obliterations after transurethral resection of the bladder tumors.
Urol Clin North Am
February 2025
Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan 20162, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, Milan 20122, Italy.
Urologic trauma encompassed a wide range of injuries affecting the urologic tract, resulting from various traumatic events or iatrogenic procedures. This review explores the clinical presentation, diagnostic strategies, and management approaches of urologic trauma, emphasizing the critical role of imaging, particularly computed tomography, in accurately assessing and guiding treatment decisions. Renal, ureteral, bladder, and urethral trauma are comprehensively discussed, including mechanisms of injury, classification systems, and therapeutic interventions.
View Article and Find Full Text PDFInt J Womens Health
November 2024
Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda.
Purpose: To describe the magnitude and trend of the iatrogenic genitourinary fistula in Uganda, and the risk factors for development following the Cesarean Section (CS).
Methods: A retrospective review of charts of women with a confirmed diagnosis of genitourinary fistula at four regional fistula repair sites in Uganda between 2010 and 2021 was conducted. A fistula was classified as iatrogenic if it was; ureteric, vesico-cervical, vesico-uterine, or vaginal vault fistula that followed an obstetric or gynecological surgery.
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