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Alieva, K. Kh, N. A. Kokhreidze, A. A. Sukhotskaya, V. G. Bairov, and A. Yu Skripnik. "Herlyn–Werner–Wunderlich syndrome in the prepubescent period (literature review and clinical observations)." Andrology and Genital Surgery 21, no. 4 (February 12, 2021): 60–67. http://dx.doi.org/10.17650/2070-9781-2020-21-4-60-67.
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Herlyn–Werner–Wunderlich syndrome (OHVIRA syndrome) is a combined malformation of the genitourinary systeme, characterized by various combinations of uterus dydelphys with unilateral obstructed (or blind) hemivagina and ipsilateral renal agenesis. The causes of mistakes in diagnosis and treatment are common because of relative rarity of anomaly, insufficient awareness of practitioners about the syndrome and the lack of multidisciplinary approach. Untimely and tactically chaotic diagnosis of Herlyn–Werner–Wunderlich syndrome leads to a misconception about the clinical situation, wrong choice in treatment, and, as a consequence, to complications such as strictures, widespread adhesions and inflammation, as well as irreversible changes in the topography of organs of the small pelvis with a subsequent deterioration in reproductive status of patient. This article provides a review of the literature on the problem, considers the clinical cases of diagnosing this defect in prepubertal patients.
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Tsyganov, S. V., R. R. Safazada, and A. S. Sobolev. "Minimally invasive treatment of iatrogenic ureter injury after gynecological surgery." Experimental and Сlinical Urology 13, no. 5 (December 25, 2020): 120–24. http://dx.doi.org/10.29188/2222-8543-2020-13-5-120-124.
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Introduction. Iatrogenic trauma of the ureters accounts for 1-5.7% of all injuries to the organs of the genitourinary system, it is this that presents the greatest difficulty for diagnosis and the greatest danger in terms of the rate and frequency of development of severe, life-threatening complications (phlegmon of the retroperitoneal space, urinary peritonitis, sepsis. Description of the clinical case. Patient A., 47 years old. On June 17, 2019, laparoscopic uterine extirpation was performed for fibroids. 06/22/2019, iatrogenic injury of the lower third of the left ureter was diagnosed. Percutaneous puncture nephrostomy on the left was performed as the first stage for urine diversion. At the second stage, ureteroscopy on the left was performed, in which a burn zone was determined in the lower third of the left ureter, up to 0.5 cm in length with a defect of 1/3 of the ureteral circumference. Left kidney stenting was performed. After 2 months, the ureteral stent was replaced. At control computed tomography (4 months after surgery), the left ureter was contrasted along the entire length, no urodynamic disturbances were revealed. Discussion. Open surgical interventions for iatrogenic trauma of the ureter are long and traumatic, require a long rehabilitation period, accompanied by social maladjustment of patients, therefore the use of X-ray endoscopic methods of treatment is an effective and alternative method of treating this pathology. Conclusion. In this case, timely detection of iatrogenic damage to the ureter made it possible to perform an effective minimally invasive surgical treatment, which saved the patient from possible severe complications.
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Sparic, Radmila, Rajka Argirovic, Snezana Buzadzic, and Milica Berisavac. "Paravesical haematoma following placement of an isolated anterior mesh for cystocele repair." Vojnosanitetski pregled 70, no. 7 (2013): 697–99. http://dx.doi.org/10.2298/vsp1307699s.
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Introduction. Pelvic organ prolapse is a substantial health problem for women around the world. Given the limitations of traditional surgery in the reconstruction of normal vaginal anatomy and function in genitourinary prolapse, various synthetic implants have been developed for surgical repair. Mesh procedures are gaining in popularity, encouraged by preliminary data. Although minimally invasive and relatively safe, serious complications following these procedures have been described. Case report. We presented a patient who had underwent an isolated anterior mesh procedure and developed postoperative haematoma which required surgical intervention. Conclusion. This report suggests that minimally invasive urogynecological procedures could result in significant complications. Thus, surgeons should be familiar with effective interventions in order to manage them.
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Sood, Akshay, Hanhan Li, Jesse Sammon, Florian Roghmann, Michael Ehlert, Maxine Sun, Mani Menon, Humphrey Atiemo, and Quoc-Dien Trinh. "Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse." Canadian Urological Association Journal 8, no. 3-4 (April 14, 2014): 100. http://dx.doi.org/10.5489/cuaj.1858.
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Objectives: Robot-assisted vaginal vault suspension (RAVVS) for pelvic organ prolapse (POP) represents a minimally-invasive alternative to abdominal sacrocolpopexy. We measured perioperative outcomes and utilization rates of RAVVS.Methods: RAVVS (n = 2381) and open VVS (OVVS, n = 11080) data were extracted from the 2009-2010 Nationwide Inpatient Sample. Propensity score-matched analysis compared patients undergoing RAVVS or OVVS for complications, mortality, prolonged length-of-stay, and elevated hospital charges.Results: Use of RAVVS for POP increased from 2009 to 2010 (16.3% to 19.2%). Patients undergoing RAVVS were more likely to be white (77.2% vs. 69.6%), to carry private insurance (52.8% vs. 46.0%) and to have fewer comorbidities (Charlson Comorbidity Index [CCI] ≥1 = 17.5% vs. 26.6%). They were more likely to undergo surgery at urban (98.2% vs. 93.7%) and academic centres (75.7% vs. 56.7%). Patients undergoing RAVVS were less likely to receive a blood-transfusion (0.7% vs. 1.8%, p < 0.001) or experience prolonged length-of-stay (9.3% vs. 25.1%, p < 0.001). They had more intraoperative complications (6.0% vs. 4.2%, p < 0.001), and higher median hospital charges ($32 402 vs. $24 136, p < 0.001). Overall postoperative complications were equivalent (17.9%, p = 1.0), though there were differences in wound (0.4% vs. 1.3%, p < 0.001), genitourinary (4.9% vs. 6.5%, p = 0.009), and surgical (6.6% vs. 4.9%, p = 0.007) complications.Conclusions: The increasing use of RAVVS from 2009 to 2010 suggests a growth in the adoption of robotics to manage POP. We show that RAVVS is associated with decreased length of stay, fewer blood transfusions, as well as lower postoperative wound, genitourinary and vascular complications. The benefits of RAVVS are mitigated by higher hospital charges and higher rates of intraoperative complications.
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Enikeev, Mikhail Elikovich, Dmitry Victorovich Enikeev, Dmitry Olegovich Korolev, Olesya Vyacheslavovna Snurnitsyna, Mikhail Vladimirovich Lobanov, Aleksandr Nikolaevich Nikitin, Leonid Mikhailovich Rapoport, and Petr Vitalievich Glybochko. "Repair of cystocele and apical genital prolapse using 6-strap mesh implant." Urologia Journal 87, no. 3 (December 16, 2019): 130–36. http://dx.doi.org/10.1177/0391560319890999.
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Objective: To assess the outcomes of surgical repair of anterior apical prolapse using the 6-strap mesh implant. Study Design: The prospective study included 100 patients with genitourinary prolapse. We used advanced 6-strap mesh implant. The results were assessed at 1 (n = 100) and 12 (n = 93) months after surgery. Maximum follow-up was over 4 years. The anatomical outcomes according to the Pelvic Organ Prolapse Quantification system and intraoperative and postoperative complications were assessed. Stage II and higher prolapse was considered to be a recurrence. The quality of life and sexual function were assessed using Pelvic Organ Prolapse Distress Inventory 20, Pelvic Floor Impact Questionnaire 7, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire 12. Results: Median age was 57 years (34–78 years (95% confidence interval)). All patients had stage III cystocele. The anterior vaginal wall descent in all the patients was associated with uterine descent: 37 (37%), stage II; 60 (60%), stage III; in 3 (3%), stage IV. In eight cases, postoperative de novo stress urinary incontinence developed. The quality of life improved in 93 (93%) women as judged by the Pelvic Floor Distress Inventory 20 data and in 87 (87%) women, according to the Pelvic Floor Impact Questionnaire 7 data. The desirable anatomical result (⩽stage I according to the Pelvic Organ Prolapse Quantification system) was achieved in 97 (97%) patients. With the exception of mesh fragment excision due to erosion (grade 3a), all the complications were classified as grade I according to the Clavien–Dindo classification. Conclusion: Genitourinary prolapse repair using 6-strap mesh is efficacious and relatively safe. The method demonstrates good anatomical results in relation to both anterior and apical prolapses with relatively short-term complications.
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Morgoshiia, T. Sh. "IN THE ORIGINS OF FORMATION OF DOMESTIC UROLOGY." Herald Urology 6, no. 2 (July 15, 2018): 69–75. http://dx.doi.org/10.21886/2308-6424-2018-6-2-69-75.
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The article notes that the problems of urology of the first half of the XX century were worked out by joint efforts of surgeons and urologists who distinguished their discipline as a narrow specialty from clinical surgery. Domestic medicine, improving and developing narrow specialties in those years, created the best conditions for improving the skills of the relevant specialists, but at the same time considered it necessary to proceed from the principle that a sharp delimitation of diseases and treatment by organs can not always serve the benefit of science and the patient. Special mention should be made of special methods of research – cystoscopy, catheterization of the ureters, pyelography, etc. – have become generally accepted for urologists and surgeons. Domestic urologists developed methods of operative access to the kidney, methods of intracapsular removal of it, methods of plastic restoration of the urino-genital organs. The author analyzes significant achievements in the treatment of congenital malformations of the genitourinary system in children, especially in the transplantation of ureters into the gut with ectopia of the bladder. When injuring the pelvic bones, rational surgical treatment of the wound at the first stages of evacuation, taking into account the anatomical features of the cellular spaces of the pelvis and the functions of the pelvic organs, was the main method of preventing subsequent complications. It is shown that in those years one of the important sections of the work of the urological departments of surgical hospitals was the treatment of gunshot injuries of the urethra. To treat these injuries, we used all sorts of developed ones before the Second World War. Domestic surgery in the first half of the XX century conducted an in-depth study of the main issues of theoretical and practical surgeons and urology. Surgical disciplines, including urology, began to approach the study of pathogenesis and the entire picture of the disease, guided by the teachings of Academician I.P. Pavlov on the role and significance of the central nervous system in the life of a living organism.Disclosure: The study did not have sponsorship. The author declares no conflict of interest.
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Rusina, Yelena Ivanovna. "The role of complex preoperative urodynamic testing of continent women when planning surgery for pelvic organ prolapse." Journal of obstetrics and women's diseases 63, no. 1 (December 15, 2014): 17–25. http://dx.doi.org/10.17816/jowd63117-25.
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Women with significant genitourinary prolapse may be continent in spite of a weak urethral sphincter because of kinking of the poorly supported urethra. After the surgery for prolapse 19-30 % of the patients identify “occult” urinary incontinence due to a weak urethral sphincter. The aim of this study is to evaluate the role of complex urodynamic testing to identify “occult” urinary incontinence, neuromuscular dysfunction of the bladder and urethra for adequate combined therapy. Methods: 257 female patients with no urinary incontinence at the age of 30-86 years old were examined, before the surgery the pelvic organ prolapse of II-IV stages was reduced by Simps vaginal speculum: 102 women were clinically tested, and 155 women were complexly (clinically and urodynamically) evaluated. In addition to clinical examination urodynamic testing was made. Complex examination was repeated to all of them after 1-3 and 12-36 months after the operation. Results: Decrease of values of abdominal pressure transmission (APT) of less than 100 % was found significantly more often (38 ± 3.9 %) compared to a positive cough test while clinical exami-nation(19.4 ± 3.2 %) P < 0.001. Preoperatively detrusor overactivity was diagnosed in 12.5 ± 3.5 % and 11.8 ± 4.2 % cases, urethral instability - in 3.1 ± 1.7 % and 5.1 ± 2.8 % cases, detrusor sphincter dyssynergy - in 3.1 ± 1.7 % and 1.7 ± 1.6 % cases, detrusor hypotonia in 9.4 ± 3.0 % and 13.5 ± 4.4 % cases of patients with APT of more than 100 % and less than 100 % respectively. Patients with detrusor overactivity, urethral instability, detrusor hypotonya got medical preoperation treatment during 3 months and longer. 6 patients with detrusor-sphincter dyssynergy, detrusor hypotension were contraindicated for sling operation. Patients who had clinically and urodynamically confirmed urinary incontinence underwent simultaneous sling operations (13 women in a clinical group and 51 - in a complex group). In 12-36 months after the surgery no patient with APT of more than 100 % showed urinary incontinence. Clinically examined patients revealed totally 7 out of 102 (7.14 ± 2.5 %) complications after 12-36 months after surgery (mixed urinary incontinence in 4 cases and difunctional urination due to hypotonia detuzor in 3 cases). There are no these complications in the group of complexly examined women. Conclusions: Urodynamic testing can identify those women at risk of developing postoperative urinary incontinence and difunctional urination so that prophylactic measures can be undertaken. In cases when neuromuscular dysfunction is corrected and values of APT are less than 100 % simultaneous sling operation is reasonable.
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Goldberg, Ilana, Steven Lee Chang, Shilajit Kundu, and Eric A. Singer. "Impact of inflammatory bowel disease on urologic oncology surgical outcomes and costs of care." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 470. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.470.
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470 Background: Recent studies suggest an association between genitourinary malignancies and inflammatory bowel disease (IBD). Our objective was to investigate clinical and financial impacts of IBD on common major urologic cancer surgeries: radical prostatectomy (RP), radical cystectomy (RC), radical nephrectomy (RN), and partial nephrectomy (PN). Methods: Using ICD9 codes, the Premier Hospital Database was queried for patients who underwent one of four surgeries: RP, RC, RN, or PN from 2003 to 2015. The cohort was segregated into IBD patients and non-IBD patients. Multivariable logistic regression models were used to determine the independent impact of IBD on complication rates (by Clavien-Dindo classification and organ system) and readmission rates. Hospital cost differences between the two cohorts, adjusted to 2016 US dollars, were examined with multivariable quantile regression models. Results: Our study population included 220,192 patients with urological malignancies, 5165 (0.4%) of whom had IBD. After controlling for clinicodemographic variables, there were significantly higher odds for any complication (Clavien ≥1) for IBD patients compared to non-IBD controls for RC (Odds ratio [OR]: 3.04, 95% confidence interval [CI]: 1.25-7.43), RN (OR: 1.57, 95% CI: 1.1-2.23), and PN (OR: 1.5, 95% CI: 1.02-2.22). Specifically, IBD patients had significantly more gastrointestinal, infectious, and soft tissue complications. Readmission rates were significantly higher for IBD patients who underwent RC (OR: 2.50, 95% CI: 1.17-5.35) and PN (OR: 1.81, 95% CI: 1.17-2.80). Hospital costs were significantly elevated for IBD patients, ranging from +$893 (95% CI: 108-1677) to +$6261 (95% CI: 1861-10660). Conclusions: There was a significantly higher overall complication rate for IBD patients undergoing RC, RN, or PN compared to the non-IBD cohort. Hospital readmission rates were significantly higher for the IBD cohort who underwent RC and PN. Hospital costs associated with surgery were also increased for IBD patients. These findings may be important when counseling IBD patients about surgical outcomes and during development of enhanced recovery pathways or bundled payment programs.
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Gong, Guoqing, and K. C. Wong. "Complications of genitourinary and gynecological surgery." Seminars in Anesthesia, Perioperative Medicine and Pain 15, no. 3 (September 1996): 212–23. http://dx.doi.org/10.1016/s0277-0326(96)80012-2.
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Peshekhonov, Kirill S., Eugene S. Shpilenia, B. K. Komyakov, Oleg O. Burlaka, and Natalia V. Morozova. "Comparative evaluation of clinical efficacy, safety, and economic expenses of two endoscopic techniques for treating prostatic hyperplasia in elderly patients." HERALD of North-Western State Medical University named after I.I. Mechnikov 12, no. 3 (December 20, 2020): 41–54. http://dx.doi.org/10.17816/mechnikov34052.
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Introduction. Rapidly developing highly specialized medical care and the emergence of new medical technologies determine the trend in surgical, minimally invasive treatment of patients with lower urinary tract symptoms due to prostatic hyperplasia. Drug therapy in elderly patients with somatic diseases poses a problem of poor compliance due to pronounced side effects caused by a drug. In this group of patients, surgical treatment of prostate hyperplasia is the most preferred solution. A doctors task is to choose the optimal method of surgery which will not only provide a long-term clinical effect, but also will minimize the economic costs of both surgical intervention and the postoperative period. The emergence of various types of energies for enucleating the prostate gland in urological practice has become an attractive alternative to transurethral resection of the prostate (TURP). However, when choosing surgical endoscopic intervention, it is important to consider the economic factor, which is considered to be a crucial problem in the medical care in Russia. Modern treatment options can not only prevent serious complications, and additional surgical interventions, but also improve the quality of patients lives. However, the introduction of new technologies is impossible without taking into account data on their cost-effectiveness.
Purpose. To compare the results and evaluate cost-effectiveness of two types of BPH endoscopic surgical treatment (bTURP, HOLEP) in elderly patients (60 years old).
Materials and methods. The study includes patients who underwent two different methods of endoscopic treatment of HPV (bTURP, HOLEP) from October 2017 to September 2018. The inclusion criteria were the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume 40 cm3, maximum urine flow 15 ml/sec. The exclusion criteria were the presence of cystostomy drainage, oncological process of the urinary system, active inflammatory process of the genitourinary system, previous surgical interventions on the organs of the urinary system, and symptoms of an overactive bladder. In each group of the patients the following indicators were evaluated the international system for the total assessment of prostate diseases (IPSS and QoL), the international index of erectile function, the dynamics of postoperative changes in prostate-specific antigen, the maximum urine flow, the residual volume, safety of the operation, intraoperative and postoperative economic expenses as well as socio-economic consequences. Cost-effectiveness analysis was carried out by calculating the indicators cost-effectiveness, cost-utility, net monetary benefit. 20-year prediction of the results was carried out by building the Markov chain model.
Results. 150 patients operated within a year were examined. HOLEP has showed its clinical efficacy before bTURP in terms of the duration of surgery, the volume of tissue removed, the time of postoperative catheterization and the length of hospital stay which was significantly lower in the HOLEP group. However, the economic expenses associated with HOLEP were also higher compared to the bTURP group.
Conclusions. Holmium laser enucleation is the preferred method for surgical treatment of prostatic hyperplasia in the prostate of more than 40 cm3, from the point of view of surgical safety, effectiveness, and also the length of the patients recovery period in elderly patients. Moreover, laser operations are considered to be economically reasonable in comorbid patients associated with a minimal risk of complications.
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Ibishev, Kh S., A. T. Atadzhanova, E. A. Mamedov, and O. N. Vasilyev. "The significance of coronavirus infection in the development of reproductive and lower urinary tract lesions." Vestnik Urologii 9, no. 2 (July 10, 2021): 125–31. http://dx.doi.org/10.21886/2308-6424-2021-9-2-125-131.
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The impact of COVID-19 on the organs of the genitourinary system is of particular interest to the urologist. There is insufficient information about this influence up to date. The studies are actively developing and require long-term data analysis to determine possible long-term complications, persistent changes in physiological parameters and anatomical and histological structures, as well as to establish the possibility of regression of these changes and complications. The results obtained will undoubtedly improve not only the diagnosis, treatment and prevention of coronavirus infection and its complications, but also make it possible to predict certain disease's outcomes and changes in the function of organs and systems. In turn, this will give an understanding of the measures that need to be taken to completely avoid or minimize these complications and changes.This review focuses on the impact of COVID-19 on genitourinary organs, particularly its place in the development of the lower urinary tract and reproductive organs lesions, as well as the role of androgens in the course of SARS-CoV-2.
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Tahaineh, Sakher, Rawan Abu Mughli, Hanan I. Hakami, and Mohamad I. Al-Faham. "Conservative treatment for Brucella testicular abscesses: A case report and literature review." Canadian Urological Association Journal 9, no. 9-10 (September 9, 2015): 679. http://dx.doi.org/10.5489/cuaj.2669.
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Brucellosis is a multi-organ infectious disease that can cause genitourinary manifestations. The most common genitourinary manifestation is orchitis; however, intratesticular abscesses are a rare complication. Although surgery is the standard treatment for intratesticular abscesses, medical therapy alone can be successful. We report the case of a 36-year-old man with multiple testicular abscesses caused by relapse of systemic brucellosis. The patient presented after a history of treated systemic brucellosis with left testicular swelling and pain. An ultrasound showed multiple small testicular abscesses, and the repeat diluted brucella titer demonstrated the causative pathogen. The patient was successfully treated with 3 months of oral targeted antibiotics, with no need for drainage or orchiectomy.
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Huang, Cheng-Ju. "Rhabdomyosarcoma involving the genitourinary organs, retroperitoneum, and pelvis." Journal of Pediatric Surgery 21, no. 2 (February 1986): 101–7. http://dx.doi.org/10.1016/s0022-3468(86)80058-6.
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Oliver, Jeremie D., Ziyad S. Hammoudeh, Arya A. Akhavan, and Nho V. Tran. "Flap Reconstruction of Gastrointestinal-to-Genitourinary Fistulas: A 20-Year Experience." Journal of Reconstructive Microsurgery 35, no. 07 (February 21, 2019): 479–84. http://dx.doi.org/10.1055/s-0039-1679880.
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Background Gastrointestinal-to-genitourinary fistulas may occur secondary to obstetric complications, radiation therapy, cancer without radiation, inflammatory bowel disease, or previous surgery. Flap reconstruction is useful for complex cases refractory to standard techniques, separating the fistula tracts to aid healing. The purpose of this study was to investigate outcomes and risk factors for complications in flap reconstruction of fistulas from several different etiologies performed over a 20-year period. Methods All patients who underwent flap reconstruction between January 1995 and December 2014 were reviewed. Patient demographics, prior treatment failures, surgical indications, and comorbidities were obtained. Operative and postoperative data were collected, including flap type, length of stay, early and late complications, recurrences, and follow-up time. Operative success was defined as definitive treatment of the fistula without recurrence within 6 months. Results There were 59 patients who underwent 66 reconstructions. The overall complication rate was 59.1%. Complications included infection (21%), dehiscence (17%), and partial flap loss (1.5%). Operative success rate was 51.5%. Smoking history (p = 0.021) and body mass index (BMI) > 35 (p = 0.003) were significantly associated with increased likelihood of postoperative complications following flap reconstruction in these patients. Additionally, fistulas due to cancer resections had a higher likelihood of postoperative complications compared with fistulas due to bowel disease or obstetric complications (p = 0.04). Conclusion Flap reconstruction can be successfully used for complex or refractory gastrointestinal-to-genitourinary fistulas. However, considerable complication and recurrence rates were found in this population. Patients with a BMI > 35 and a history of smoking were at greatest risk in this cohort of experiencing postoperative complications.
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Arifi, M., S. Arifi, K. Demni, MA Bouhafs, R. Belkacem, and M. Barahioui. "Genitourinary complications as initial presentation of inherited epidermolysis bullosa." African Journal of Paediatric Surgery 8, no. 1 (2011): 72. http://dx.doi.org/10.4103/0189-6725.78673.
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Н.Б., Максумова, Ниязметов Р.Э., Матякубов Б.Б., and Усинова З.Б. "РОЛЬ МЕСТНОГО ИСПОЛЬЗОВАНИЯ КОНЪЮГИРОВАННОГО ЭСТРОГЕНА В УЛУЧШЕНИИ ИСХОДОВ ОПЕРАТИВНОГО ЛЕЧЕНИЯ ПРОЛАПСА ГЕНИТАЛИЙ." Innova 15 (June 20, 2019): 20–23. http://dx.doi.org/10.21626/innova/2018.3/03.
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The available surgical methods for the treatment of genital prolapse cannot guarantee the absence of complications in the postoperative period and relapse. In this article, we describe the possibilities of preventing postoperative complications and repeated episodes of prolapse of the genital organs of local hormonal therapy with conjugated estrogen (femistrone) preparations, which directly improves the regenerative processes in the tissues of the genitourinary system. Based on our clinical experience, we came to the conclusion about the high efficacy and safety of topical application of conjugated estrogen (femistrone) for 5-7 days in the preparation of the vaginal walls for surgical treatment.
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Н.Б., Максумова, Ниязметов Р.Э., Матякубов Б.Б., and Усинова З.Б. "РОЛЬ МЕСТНОГО ИСПОЛЬЗОВАНИЯ КОНЪЮГИРОВАННОГО ЭСТРОГЕНА В УЛУЧШЕНИИ ИСХОДОВ ОПЕРАТИВНОГО ЛЕЧЕНИЯ ПРОЛАПСА ГЕНИТАЛИЙ." Innova 15 (June 20, 2019): 20–23. http://dx.doi.org/10.21626/innova/2019.2/03.
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The available surgical methods for the treatment of genital prolapse cannot guarantee the absence of complications in the postoperative period and relapse. In this article, we describe the possibilities of preventing postoperative complications and repeated episodes of prolapse of the genital organs of local hormonal therapy with conjugated estrogen (femistrone) preparations, which directly improves the regenerative processes in the tissues of the genitourinary system. Based on our clinical experience, we came to the conclusion about the high efficacy and safety of topical application of conjugated estrogen (femistrone) for 5-7 days in the preparation of the vaginal walls for surgical treatment.
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OʼCONNELL, KEVIN J., MICHAEL CLARK, RICHARD H. LEWIS, and PAUL J. CHRISTENSON. "Comparison of Low- and High-Velocity Ballistic Trauma to Genitourinary Organs." Journal of Trauma: Injury, Infection, and Critical Care 28, Supplement (January 1988): S139—S144. http://dx.doi.org/10.1097/00005373-198801001-00028.
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Michalkiewicz, Edson L., Bhaskar N. Rao, Eitan Gross, Xiaolong Luo, Laura C. Bowman, Alberto S. Pappo, Sue C. Kaste, et al. "Complications of pelvic exenteration in children who have genitourinary rhabdomyosarcoma." Journal of Pediatric Surgery 32, no. 9 (September 1997): 1277–82. http://dx.doi.org/10.1016/s0022-3468(97)90301-8.
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Mandava, Anitha, Veeraiah Koppula, Gaurav Sharma, Meghana Kandati, K. V. V. N. Raju, and T. Subramanyeshwar Rao. "Evaluation of genitourinary fistulas in pelvic malignancies with etiopathologic correlation: role of cross sectional imaging in detection and management." British Journal of Radiology 93, no. 1111 (July 2020): 20200049. http://dx.doi.org/10.1259/bjr.20200049.
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Objective: Genitourinary fistulas in pelvic malignancies are abnormal communications occurring due to either locally advanced tumours invading the surrounding organs or post-therapeutic complications of malignancies. In this article we review and describe the role of cross-sectional imaging findings in the management of genitourinary fistulas in pelvic malignancies. Methods: A retrospective study, for the period January 2012 to December 2018, was undertaken in patients with pelvic malignancies having genitourinary fistulas. The cross-sectional (CT and MRI) imaging findings in various types of fistulas were reviewed and correlated with the primary malignancy and the underlying etiopathology. Results: Genitourinary fistulas were observed in 71 patients (6 males, 65 females). 11 types of fistulas were identified in carcinomas of cervix, rectum, ovary, urinary bladder, sigmoid colon, vault, endometrium and prostate. The commonest were rectovaginal and vesicovaginal fistulas. 13 patients had multiple fistulas. The sensitivity, specificity, positive and negative predictive values of CT and MRI are 98%, 100%, 66%, 98% and 95%, 25%, 88% and 50% respectively. Contrast-enhanced CT with oral and rectal contrast is more sensitive and specific than MRI in the evaluation of genitourinary fistulas. Conclusion: Imaging findings significantly influence the management and outcome of genitourinary fistulas in pelvic malignancies. Contrast-enhanced CT is the imaging modality of choice in the evaluation of pelvic fistulas associated with malignancies and MRI is complimentary to it. Advances in knowledge: To our knowledge, this study is the first of its kind wherein the mean duration of occurrence of fistulas in pelvic malignancies is correlated with the underlying etiopathology.
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Alatorskikh, A. E., P. V. Fedorych, L. V. Grechanska, and S. B. Koval. "BACTERIAL VAGINOSIS: A LOOK AT THE PROBLEM. REVIEW OF LITERARY SOURCES." Dermatology and Venerology, no. 4 (2020): 8–11. http://dx.doi.org/10.33743/2308-1066-2020-4-8-11.
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One of the leading diseases of the genitourinary system in women of reproductive age is occupied by infectious diseases that are associated with changes in the normal biocenosis of the vagina. It is these changes with a shift in the composition of the vaginal microflora towards anaerobic and microaerophilic opportunistic pathogens that are the background on which inflammatory diseases of the genitourinary system of women are able to develop almost without hindrance. The literature suggests that the diversity of the spectrum of microorganisms that are associated with bacterial vaginosis can complicate not only the local immune response, but also the immunological reactivity of the body as a whole. Scientific and practical interest in this problem is due to the pathogenetic link of vaginal dysbiosis with inflammatory diseases of the pelvic organs, as well as the possible possibility of complications or complications of chronic dermatoses due to immune system disorders in relevant patients with bacterial vaginosis. Literature data on the most significant modern aspects of bacterial vaginosis are given. It has been suggested that the microflora associated with bacterial vaginosis, mediated by the immune system, may be affected by the occurrence and / or course of chronic dermatoses.
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Меlnyk, V. М., Ye М. Shepetko, І. І. Polovnikov, and О. І. Poyda. "Іnnovation technologies in the gut organs surgery." Klinicheskaia khirurgiia 85, no. 6 (July 26, 2018): 5–9. http://dx.doi.org/10.26779/2522-1396.2018.06.05.
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Objective. To improve the surgical treatment results in patients, suffering the gut organs diseases, due to its sophistication and elaboration of modern innovation technologies.
Маterials and methods. In the work the author’s concept and results of the modern innovative technologies while performing surgery on the gut organs for ulcerative hemorrhage, complicated postbulbar, parapapillary ulcers, gastric cancer and polyps, colorectal cancer, ulcerative colitis, Crohn’s disease of large bowel, familial adenomatous polyposis are adduced. Endoscopic operations, methods of atraumatic dissection of tissues, new restoration and reconstructive-restorative operations, using modern staplers for anastomoses formation, laparoscopic operations were applied. The innovative surgical technologies were applied in 2428 patients.
Results. Using methods of endoscopic hemostasis a definitive arrest of ulcerative hemorrhage was achieved in 91.1% patients. Еndoscopic polypectomy for the large bowel polyps of significant size and for «spreading» polyps were performed in 90.5% patients. Occurrence of postoperative hemorrhage was reduced to 0.74%, а large bowel wall perforation was not observed. In patients with complicated postbulbar and parapapillary ulcers the postoperative morbidity was reduced tо 24.7%, postoperative lethality - tо 7.6%. More favorable functional results were obtained after gastroplastic operations. Postoperative complications have occurred in 15.8% patients, 1.7% patients died.
Conclusion. Modern innovation surgical technologies, including endoscopic, staplers for anastomoses formation, methods of atraumatic dissection of tissues, reconstructive-restorative, laparoscopic surgical interventions are sufficiently effective in the treatment of patients, suffering diseases of the gut organs. Application of modern innovation technologies in the gut organs surgery makes possible to eliminate pathological process, its complications, to reduce significantly the surgical interventions traumaticity, time of their performance, quantity of postoperative complications, lethality, and to improve functional results and quality of life in the patients operated.
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Alekseev, B. Ya, A. S. Kalpinskiy, I. A. Taraki, A. A. Mukhomed’yarova, K. М. Nyushko, N. V. Vorobyev, A. A. Kostin, and A. D. Kaprin. "POSSIBILITIES OF ORGAN-PRESERVING TREATMENT OF PATIENTS WITH MULTIPLE RENAL TUMORS." Research'n Practical Medicine Journal 4, no. 2 (June 17, 2017): 54–60. http://dx.doi.org/10.17709/2409-2231-2017-4-2-7.
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Renal cell carcinoma (RCC) occupies one of the leading places in the world for morbidity among malignant neoplasms of the genitourinary system. The frequency of occurrence of bilateral RCC according to different authors is 2–6% of the total population of patients with RCC. Currently, the only effective method of treatment of bilateral RCC is surgical treatment. Patients with bilateral RCC are at high risk of dev eloping of local recurrence or progression of the disease after organ-preserving surgeries, which is why the surgeon is faced with a choice between a high risk of developing renal failure or relapse and/or progression of the disease, depending on the extent of the surgical intervention. According to the literature, in patients with bilateral RCC there was an increase in the incidence of papillary variant of RCC up to 19% and the presence of multifocal lesion. Surgical treatment of bilateral RCC is the only effective method to achieve satisfactory oncological results at a low incidence of complications. The m ost justified option for the treatment of bilateral RCC is the implementation of bilateral organ-preserving treatment, which allows achieving the optimal functional results. This article presents a clinical case of successful surgical treatment of a patient with bilateral RCC with multiple tumors.
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Lagadinou, Maria, Virginia Mplani, Dimitrios Velissaris, Periklis Davlouros, and Markos Marangos. "Myocarditis Caused by Brucella melitensis in the Absence of Endocarditis: Case Report and Review of the Literature." Case Reports in Medicine 2019 (February 10, 2019): 1–4. http://dx.doi.org/10.1155/2019/3701016.
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Brucellosis remains an important public health problem with endemic characteristics in many countries. Brucellosis can affect almost all organs and systems of human body. Cardiac complications are unusual, occurring in less than 2% of patients and usually manifest as endocarditis. We present the case of a 21-year-old Caucasian man, who was admitted to the University Hospital of Patras, Western Greece, with fatigue, fever up to 39°C, and retrosternal pain. Musculoskeletal, genitourinary, gastrointestinal, hematologic, nervous, skin, and mucous membranes and respiratory complications have been reported in several cases of brucellosis. Development of myocarditis is a highly rare complication of brucellosis, particularly in the absence of concomitant endocarditis. Clinicians should be aware of this clinical entity especially in endemic areas as appropriate antibiotic treatment is life-saving and may prevent serious cardiologic disorders.
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Rettenmaier, Christopher R., Nicholas B. Rettenmaier, Lisa N. Abaid, John V. Brown, John P. Micha, Alberto A. Mendivil, Tomasz Wojciechowski, Bram H. Goldstein, and Maurie Markman. "The Incidence of Genitourinary and Gastrointestinal Complications in Open and Endoscopic Gynecologic Cancer Surgery." Oncology 86, no. 5-6 (2014): 303–7. http://dx.doi.org/10.1159/000360294.
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Dalpiaz, Amanda, Jason Gandhi, Noel L. Smith, Gautam Dagur, Richard Schwamb, Steven J. Weissbart, and Sardar Ali Khan. "Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy." Current Urology 9, no. 4 (2015): 169–78. http://dx.doi.org/10.1159/000447136.
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Introduction: Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods. Methods: Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature. Results: Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases. Conclusion: Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms.
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Kim, Yeo-Kyeoung, Soo-Mee Bang, Moon Ju Jang, Ho-Young Yhim, Won-Il Choi, Kyoung Ha Kim, Sung Hwa Bae, et al. "Incidence Of VTE Following Genitourinary Surgery In Korea and Evidence-Based Korean Guidelines For Preventing VTE In Patients Undergoing Genitourinary Surgery." Blood 122, no. 21 (November 15, 2013): 1138. http://dx.doi.org/10.1182/blood.v122.21.1138.1138.
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Abstract Introduction Venous thromboembolism (VTE) is a major cause of morbidity and mortality after gynecologic and urologic surgeries and previously reported VTE incidence in major genitourinary surgery without VTE prophylaxis was 15-40% in Western countries. VTE is a preventable complication using thromboprophylaxis, however, pharmacologic thromboprophylaxis after major abdomino-pelvic surgery may involve serious bleeding complication. Here, we evaluated the exact incidence and risk factors of VTE following major genitourinary surgery in Korean patients and proposed evidence-based VTE prevention guidelines in such patients. Methods In March 2012, the committee for the development of guidelines for preventing VTE in Korea was organized by receiving recommendations from the VTE working party members in the Korean Society on Thrombosis and Hemostasis (KSTH). Using nation-wide date from Korea Health Insurance Review and Assessment Service (HIRA) from 2007 to 2011, symptomatic VTE frequencies after major genitourinary surgeries were retrospectively collected and evaluated. For the categorization of those patients by their VTE incidences, we used the methods described in AT9 guidelines (American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 9th ed.) Results According to the HIRA database, 255,324 and 85,191 patients' data were collected and evaluated their incidence of VTE and risk factors, which underwent major gynecologic and urologic surgeries, respectively. In detail, there were 87,136 hysterectomies for benign uterine diseases (76,284) and uterine cervical cancer (10,852), 168,188 oophorectomies for benign ovarian diseases (156,697) and ovarian cancer (11,491), 35,970 prostatectomies for benign prostatic hyperplasia (BPH, transurethral, 26,590) and prostatic cancer (retropubic, 9,380), 12,462 nephrectomies for renal cell cancer and 36,759 radical cystectomies for bladder cancer. As shown in Table 1, most Korean patients undergoing genitourinary surgeries were identified as very low VTE risk category. In the aspect of gynecologic cancer surgery, ovarian cancer showed highest rate of VTE incidence (1.21%, moderate risk; 0.70% deep vein thrombosis, DVT + 0.51% pulmonary embolism, PE) and cervical cancer showed 0.59% (low risk; 0.47% DVT + 0.12% PE). On the basis of these data and a literature search results, the recommendation was made by a consensus of the guideline development committee. To take the advice of outside experts, survey and review for the developed guidelines were performed by other KSTH members and the related Academic Societies. Conclusions Even when considering relatively lower incidence of VTE in Asian people than that in Western, Korean genitourinary surgery patients revealed very low incidence of VTE. As stated above, abdomino-pelvic surgery is a procedure for high risk of bleeding complications. Therefore, it is reasonable to assume that the recommendation of pharmacologic thromboprophylaxis for other gynecologic surgeries except ovarian cancer surgery should be deferred until they reveal hard evidence of higher incidence of VTE in Korea. Disclosures: No relevant conflicts of interest to declare.
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Syplyviy, V. A., I. A. Kryvoruchko, A. V. Ievtushenko, B. V. Menkus, and D. V. Ievtushenko. "RELAPAROTOMY IN THE TREATMENT OF INTRA-ABDOMINAL COMPLICATIONS OF ABDOMINAL SURGERY." Kharkiv Surgical School, no. 2 (April 20, 2020): 156–60. http://dx.doi.org/10.37699/2308-7005.2.2020.31.
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Summary. Relaparotomy in the treatment of postoperative complications of abdominal surgery remains a complex problem in modern surgery.
Purpose: to study the causes of relaparotomy after surgical operations on the abdominal organs, depending on the nature of the first surgical intervention.
Material and Methods: A retrospective analysis of the performance of 74 relaparotomies after surgical treatment of abdominal pathology was performed. The first surgical intervention was performed because of acute cholecystitis (11 patients), choledocholithiasis (4), acute destructive appendicitis (8), perforated stomach or duodenal ulcers (8), strangulated hernia (5), adhesive intestinal obstruction (9), perforation of thin or colon (7), obstruction of the colon of tumor origin (19). Indications for relaparotomy were peritonitis, early adhesive intestinal obstruction, intraperitoneal bleeding.
Conclusions: Complications associated with intra-abdominal infection — peritonitis, peritonitis due to insolvency of anastomotic sutures, is the most common cause of relaparotomy after operations on the abdominal organs, requires improvement of both technology of operations and antibacterial therapy. Relaparotomy is a life-saving surgery in the development of intra-abdominal complications, but it is associated with a greater risk of mortality.
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Dangle, Pankaj P., Andy Lee, Rajeev Chaudhry, and Francis X. Schneck. "Surgical Complications Following Early Genitourinary Reconstructive Surgery for Congenital Adrenal Hyperplasia—Interim Analysis at 6 Years." Urology 101 (March 2017): 111–15. http://dx.doi.org/10.1016/j.urology.2016.11.027.
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Teegala, Ramesh, Ramesh Kanumury, Nagendra Babu, and BTS Sai. "Ventriculo Peritoneal shunt catheter penetrating the Kidney: An unusual complication of shunt surgery." Nepal Journal of Neuroscience 15, no. 1 (May 28, 2018): 27–28. http://dx.doi.org/10.3126/njn.v15i1.20024.
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Ventriculo Peritoneal (VP) shunt surgery is one of the commonly performed neurosurgical procedure in the management of hydrocephalus. Numerous complications related to this procedure are reported in the literature. Shunt malfunction related to the abdominal catheter is seen nearly 10-40% of cases. The catheter can perforate hollow viscous or solid organs. Among the solid organs, the kidney penetration was not reported in the English literature. We report an unusual case of VP shunt abdominal catheter migration in to kidney Ventriculo peritoneal shunt being one of the commonest procedures done by any neurosurgeon has many complications. Among them abdominal catheter complications like halo viscous perforation, abdominal wall perforation and extrusion through the natural orifices are considered to be rare. Solid organ perforations are very unusual and very limited numbers of these are reported.Nepal Journal of Neuroscience 15:27-28, 2018
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Karahasan, Hasan, Dženita Ljuca, Nermin Karahasan, Alija Šuko, Adnan Babović, and Hidajet Rahimić. "Antibiotic prophylaxis and inflammatory complications after Cesarean section." Journal of Health Sciences 1, no. 3 (December 15, 2011): 145–48. http://dx.doi.org/10.17532/jhsci.2011.128.
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Introduction: Gynaecological and obstetric surgeries are high risk operations for the development of postoperative inflammatory complications due to the proximity of the genitourinary tract. The aim of this study was to compare the frequency of inflammatory complications in emergency or elective cases of caesarean sections as well as the frequency of complications related to the method of surgical treatment used.Methods: We analyzed inflammatory complications in 450 caesarean sections, which developed in a one year period from June 1st, 2000. to June 1st 2001. Patients were grouped according to the method of the surgery, and on emergency or elective case. Misgav Ladach or Dorfler surgical methods were used.Results: The most common inflammatory complication was wound infection and the most common risk factors for inflammatory complications were premature rupture of membranes and anemia.Conclusions: Long term use of one antibiotic was the most commonly implemented form of antibiotic prophylaxis.
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Khudair, Ayad Y. "Management of retroperitoneal hematoma." Muthanna Medical Journal 7, no. 2 (December 19, 2020): 71–78. http://dx.doi.org/10.52113/1/7.2/2020.78.
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Retroperitoneal traumatic lesions are among the most challenging and serious emergencies, and necessitate a maximum of attention and expertise by the surgical team involved. Only with a careful judgment about the procedures to carry on it is possible to obtain valid results, which often means to safe the patients life. This is a prospective study, which included 30 patients with traumatic retroperitoneal hematoma, admitted to AL-Hussien Teaching Hospital for the period between Dec. 2017 – Nov. 2019 (22 months). They were analyzed regarding age, sex, type of trauma, signs and symptoms, relevant laboratory tests and radiological studies, operative findings, associated organ injured, methods of treatment, postoperative complications and their mortality rate. Most patients were males (77.2%). Young age group was more frequently injured (34.85%) of patients were in their third decade. Penetrating injury was the cause in majority of collected patients (83.3%). The commonest zone of retroperitoneal hematoma was zone 2 (74.24%) and the commonest site was the lateral perirenal hematoma. In conclusion; the presence of lesions on the retroperitoneum generally worsens the prognosis in traumatic pathology. All types of trauma, blunt or open, may involve retroperitoneal structures and organs. Associated abdominal organs injury may include the great vessels, pancreas, duodenum, oesophagus and genitourinary apparatus.
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khudair, Ayad Y. "Management of retroperitoneal hematoma." Muthanna Medical Journal 7, no. 2 (December 21, 2020): 71–78. http://dx.doi.org/10.52113/1/7.2/20.71.
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Retroperitoneal traumatic lesions are among the most challenging and serious emergencies, and necessitate a maximum of attention and expertise by the surgical team involved. Only with a careful judgment about the procedures to carry on it is possible to obtain valid results, which often means to safe the patients life. This is a prospective study, which included 30 patients with traumatic retroperitoneal hematoma, admitted to AL-Hussien Teaching Hospital for the period between Dec. 2017 – Nov. 2019 (22 months). They were analyzed regarding age, sex, type of trauma, signs and symptoms, relevant laboratory tests and radiological studies, operative findings, associated organ injured, methods of treatment, postoperative complications and their mortality rate. Most patients were males (77.2%). Young age group was more frequently injured (34.85%) of patients were in their third decade. Penetrating injury was the cause in majority of collected patients (83.3%). The commonest zone of retroperitoneal hematoma was zone 2 (74.24%) and the commonest site was the lateral perirenal hematoma. In conclusion; the presence of lesions on the retroperitoneum generally worsens the prognosis in traumatic pathology. All types of trauma, blunt or open, may involve retroperitoneal structures and organs. Associated abdominal organs injury may include the great vessels, pancreas, duodenum, oesophagus and genitourinary apparatus.
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Nestler, Tim, Pia Paffenholz, David Pfister, Andreas Hiester, Alessandro Nini, Peter Albers, and Axel Heidenreich. "Evaluation of the oncologic benefit of adjunctive surgery at time of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND)." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 388. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.388.
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388 Background: PC-RPLND for advanced nonseminomatous germ cell tumors aims to resect all remaining metastatic tissue. The resection of adjacent visceral or vascular organs is commonly performed to achieving complete resection of the residual masses. However, the frequency of metastatic involvement of those organs with teratoma or vital cancer is currently unknown. Methods: We reviewed a cohort of 1181 patients who underwent PC-RPLND between 2008 and 2018 as a 2-center study and identified 235 (20%) cases of adjunctive surgery during PC-RPLND. We analysed the pathohistological presence of germ cell tumor elements in the resected organs: viable tumor (V), teratoma (T) or necrosis / fibrosis (N). Surgery associated complications were reported according to the Clavien-Dindo classification. Outcomes of subgroups were compared by using log-rank test. Results: V, T, N was present in 51 (21%), 91 (39%) and 93 (40%) of all patients with adjunct resected organs. In 235 patients, 316 adjunct organs were resected with 64 (27%) of these patients receiving a resection of multiple organs. The kidney was the most often resected organ (n = 74; V: 27% T: 39% N: 34%), followed by V. Cava (n = 66; V: 24% T: 36%, N: 40%) and partial liver resections (n = 48; V: 15%, T: 31%, N: 54%). Intraoperative complications occurred in 21% of patients (VT 32% vs N 17%, p = 0.021). Postoperative complications occurred in 35% of which 22% were Clavien Grad III-V showing no significant differences between VTN p = 0.093. 27% of all patients suffered from a relapse during a median follow-up of 22 months [0-180]. Patients with T or V in the resected specimens had a significantly reduced 5-year RFS compared to patients with only N (39%, 81%, p < 0.001). Conclusions: This study shows for the first time that 40% of all resections of adjunct organs are oncologically unnecessary due to the presence of N only in the pathological specimens. In case of doubt we propose an organ safe procedure with multiple intraoperative frozen section to avoiding oncologically unnecessary adjunctive surgeries especially nephrectomies and vascular resections. Additionally, a more accurate presurgical workup is required to spare patients with N from PC-RPLND.
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Rettenmaier, Christopher, Nicholas Rettenmaier, Lisa Abaid, Alberto Mendivil, John V. Brown, John P. Micha, Katrina Lopez, Tomasz Wojciechowski, and Bram Goldstein. "The incidence of vascular, genitourinary, and intestinal tract injuries in gynecologic oncology: An extensive, single institutional experience." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e15500-e15500. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e15500.
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e15500 Background: Iatrogenic vascular, genitourinary, and intestinal tract injuries are an unfortunate consequence in gynecologic surgery because the uterus and ovaries are adjacent to critical pelvic structures. The incidence of these complications in general gynecology reportedly varies from 0.3-8.0%; conversely, in gynecologic oncology, the rate is presumably higher although the outcomes are not well documented. Methods: We reviewed the charts of gynecologic oncology patients treated at a single medical institution from January 2003 to February 2011. The following study variables were noted for evaluation: patient characteristics (age, body mass index (BMI)), medical history, cancer origin (e.g., ovarian, uterine), disease pathology, previous pelvic surgery, injury type (genitourinary, vascular or intestinal tract) and injury diagnosis (intra- or post-operative). Descriptive analyses were initially employed, followed by further evaluation of the clinicopathologic parameters via logistic regression, ANOVA and Cox proportional-hazard ratios. Results: In the current, retrospective investigation, 810 gynecologic cancer patients were identified; from this group, there were 25 (3.1%) intestinal tract, 10 (1.2%) genitourinary and 20 (2.5%) vascular injuries encountered. The logistic regression model classified correctly 84% of the injuries. Moreover, a Cox proportional hazard model revealed that cancer origin (p=0.023), previous pelvic surgery (p=.003), BMI (p=0.002) and disease stage (p < 0.01) were surrogate markers for operative injury occurrence. Conclusions: The incidence of vascular, genitourinary and intestinal tract injuries in this large group of gynecologic oncology patients was quite reasonable. Fortunately, when these conditions arise, gynecologic oncologists have extensive surgical experience and are well prepared to address them. Additional study of the clinicopathologic factors that may predispose these cancer patients to a surgical complication is necessary.
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Schmidt, Line, Kristoffer Andresen, and Jacob Rosenberg. "No difference in genitourinary complications after laparoscopic vs. open groin hernia repair in women: a nationwide linked register-based cohort study." Surgical Endoscopy 34, no. 5 (July 15, 2019): 1978–84. http://dx.doi.org/10.1007/s00464-019-06973-x.
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Yu, Hao, Linlin Zhang, Dapeng Li, Naifu Liu, Yueju Yin, Lu Zhang, Lingqin Yuan, Ming Liu, and Xiugui Sheng. "Postoperative adjuvant chemotherapy combined with intracavitary brachytherapy achieved the equivalent survival compared with concurrent chemoradiotherapy in cervical cancer patients with intermediate-risk." Japanese Journal of Clinical Oncology 49, no. 8 (April 24, 2019): 714–18. http://dx.doi.org/10.1093/jjco/hyz057.
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Abstract Objectives The current study was aimed to evaluate the efficacy and toxicity of postoperative adjuvant chemotherapy (CT) combined with intracavitary brachytherapy (ICRT) in cervical cancer patients with intermediate-risk. Methods We analyzed the medical records of 558 patients who were submitted to radical surgery for Stage IB-IIA cervical cancer. A total of 172 of those 558 patients were considered intermediate-risk according to the GOG criteria. Among those 172 patients, 102 were subjected to CT combined with ICRT (CT+ICRT) and the remaining 70 patients were treated with concurrent chemoradiation (CCRT). The 3-year disease free survival (DFS), overall survival (OS), and complications of each group were evaluated and analyzed. Results No significant difference was observed in 3-year DFS or OS of the patients submitted to CT+ICRT and CCRT. Importantly, the frequencies of grade III to IV acute complications were significantly higher in patients submitted to CCRT than in those treated with CT+ICRT (Hematologic, P = 0.016; Gastrointestinal, P = 0.041; Genitourinary, P = 0.019). Moreover, the frequencies of grade III–IV late complications in patients treated with CCRT were significantly higher compared with CT+ICRT-treated patients (Gastrointestinal, P = 0.026; Genitourinary, P = 0.026; Lower extremity edema, P = 0.008). Conclusions Postoperative adjuvant CT+ICRT treatment achieved equivalent 3-year DFS and OS but low complication rate compared to CCRT treatment in early stage cervical cancer patients with intermediate-risk.
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Afanasyev, Sergey, Igor Khadagaev, Sergey Fursov, Evgeniy Usynin, Aleksey Gorbunov, Umidzhon Urmonov, Anna Usova, Aleksandra Avgustinovich, and Anna Tarasova. "EXPERIENCE OF MULTIVISCERAL RESECTIONS IN LOCALLY ADVANCED AND PRIMARY-MULTIPLE RECTAL CANCER." Avicenna Bulletin 22, no. 1 (March 1, 2020): 82–90. http://dx.doi.org/10.25005/2074-0581-2020-22-1-82-90.
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Objective: Assessing short-term and long-term results of multivisceral resections (MVR) performed for rectal cancer (RC) with invasion into adjacent pelvic organs, as well as the effectiveness of bladder reconstruction with the formation of a urinary reservoir of «low» pressure. Methods: The work was based on the results of surgical treatment of 37 patients with locally advanced or primary multiple RC underwent MVR. Invasion of adjacent small organs was observed in 89.2%, primary multiple malignant tumors (PMMT) – in 10.8% of patients included in the study. Results: According to the preoperative examination of tumor infiltration of one adjacent organ was diagnosed in 20 (54.1%), two or more organs – in 17 (45.9%) observations; more often affected the bladder – in 18 (48.6%) cases. Volumes of performed operations: in 6 (16.2%) cases of complete pelvic organs evisceration, in 10 (27%) cases of MVR with rectal extirpation, in 21 (56.8%) cases of MVR with resection of the rectum and adjacent organs. More often in 27 (72.9%) patients, there was urinary tract resection, of which 11 (29.7%) patients underwent primary bladder repair with the formation of ortho- (n=3) or heterotopic (n=6) urinary reservoir of «low» pressure. Postoperative complications developed in 14 (37.8%) patients, what required re-surgery in 8 (21.6%) observed, of which urological complications occurred in 4 (10.8%) patients. Complications were not observed during the formation of the artificial bladder according to the presented method. Long-term results: RC – overall and disease-free 2-year survival – 78.1% and 65.6% respectively, PMMT – all patients are alive without signs of relapse, the timeline of observation is 24 months. Conclusions: The immediate results of MVR on locally advanced RC can be considered as satisfactory. The level of postoperative complications is primarily due to the prevalence of primary tumors. In case of urinary tract resection, primary plastic surgery is preferred. Long-term results allows to examine such operations as a method of choice in the treatment of RC with invasion in adjacent organs. Keywords: Rectal cancer, surgical treatment, multivisceral resection, bladder reconstruction, postoperative complications, disease-free survival.
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Mirilas, Petros, and John E. Skandalakis. "Surgical Anatomy of the Retroperitoneal Spaces, Part V: Surgical Applications and Complications." American Surgeon 76, no. 4 (April 2010): 358–64. http://dx.doi.org/10.1177/000313481007600410.
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Knowledge of the surgical anatomy of the retroperitoneum is crucial for surgery of the retroperitoneal organs. Surgery is essential for treatment of retroperitoneal pathologies. The list of these diseases is extensive and comprises acute and chronic inflammatory processes (abscess, injury, hematoma, idiopathic fibrosis), metastatic neoplasms, and primary neoplasms from fibroadipose tissue, connective tissue, smooth and striated muscle, vascular tissue, somatic and sympathetic nervous tissue, extraadrenal chromaffin tissue, and lymphatic tissue. The retroperitoneum can be approached and explored by several routes, including the transperitoneal route and the extraperitoneal route. The retroperitoneal approach to the iliac fossa is used for ectopic renal transplantation. Safe and reliable primary retroperitoneal access can be performed for laparoscopic exploration. The anatomic complications of retroperitoneal surgery are the complications of the organs located in several compartments of the retroperitoneal space. Complications may arise from incisions to the somatic wall, somatic nerves, blood and lymphatic vessels, lymph nodes, visceral autonomous plexuses, and neighboring splanchna.
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Gasparov, A. S., I. A. Babicheva, E. D. Dubinskaya, N. V. Lapteva, and M. F. Dorfman. "Surgical treatment for pelvic organs prolapse." Kazan medical journal 95, no. 3 (June 15, 2014): 341–47. http://dx.doi.org/10.17816/kmj1510.
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Aim. To estimate and compare the features and efficacy of different surgical methods of pelvic organ prolapse correction. Methods. 120 patients with stage 4 of pelvis organ prolapse were included in the study. The different types of surgical procedures were performed («Manchester» surgery, vaginal hysterectomy, sacropexy, laparoscopic ventrosuspension). Surgical method was selected accounting the patient’s age, desire to save the uterus, presence of uterine or adnexal pathology and concomitant diseases. For long-term outcomes evaluation, patients were followed up for 6-36 month after surgery. Results. The long-term outcomes of the different types of surgeries performed in patients with stage 4 of pelvis organ prolapse were comparable. Minimal surgery time, blood loss and the hospital stay were registered in patients, in whom laparoscopic ventrosuspension combined with colpoperineorrhaphy and levatorplasty was performed, compared to «Manchester» surgery, vaginal hysterectomy and sacropexy with colpoperineoplasty. No cases of serious complications were registered. Patients with stress incontinence observed before surgery reported improvement in urination, although 6 patients (10%) still reported rare episodes of incontinence. Conclusion. In elderly patients with stage 4 of pelvis organ prolapse, laparoscopic ventrosuspension of uterus or vaginal stump with further colpoperineorrhaphy and levatorplasty could be performed; this type of surgery is technically simple, not time-consuming, and it’s results are comparable with the effectiveness of sacropexia. Thus, it could be recommended to under-trained young surgeons.
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Özcan, Hüseyin, Özcan Balat, Mete Uğur, Seyhun Sucu, Neslihan Tepe, and Tanyeli Kazaz. "Use of Bladder Filling to Prevent Urinary System Complications in the Management of Placenta Percreta: a Randomized Prospective Study." Geburtshilfe und Frauenheilkunde 78, no. 02 (February 2018): 173–78. http://dx.doi.org/10.1055/s-0044-100039.
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Abstract Introduction The aim of our study was to evaluate the effect of filling the bladder on peripartum genitourinary injuries (especially bladder complications) in women with placenta percreta and to compare patient characteristics. Material and Methods Our prospective cohort study consisted of pregnant women with placenta percreta who underwent planned cesarean hysterectomy at the Department of Obstetrics and Gynecology of Gaziantep University Hospital between January 2015 and July 2016. Bladders were filled with 300 ml saline solution to determine surgical borders better and enable dissection of the lower uterine segment without excessive bleeding or unintended injury. Results A total of 66 women were included in the study: 32 women whose bladders were filled during surgery (filled-bladder group) and 34 women whose bladders were not filled (not filled-bladder group). Comparisons of demographic and obstetrical data, surgical parameters, the need for transfusion, and bladder injury rates revealed no significant differences between the two groups. We did not observe any beneficial effect of filling the bladder on preventing urinary complications compared with the women whose bladders were not filled (p = 0.339). Conclusions Filling the bladder with saline solution and mobilization of the bladder from the lower uterine segment did not have a statistically significant beneficial effect on preventing complications of the genitourinary system. But although the beneficial effects were not significant, shorter operation times, shorter postoperative hospital stays, and fewer bladder injuries were noted in patients whose bladders were filled.
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Yrysov, K. B., and N. D. Mamashev. "Peculiarities of surgical management of combined echinococcosis." Bulletin of Siberian Medicine 7, no. 5-2 (December 30, 2008): 478–80. http://dx.doi.org/10.20538/1682-0363-2008-5-2-478-480.
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Surgery has remained the mainstay for the management of hydatid cysts. The success of any operation depends to a great extension how well the optimal surgical approach is chosen and which method of residual cyst sanitation. The purpose of the study was to analyze of complications after combined cyst, brain and abdominal, surgery. The complications associate with depth, size and relation to adjacent organs.
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Wells, Gregg B., Todd M. Lasner, David M. Yousem, and Eric L. Zager. "Lhermitte-Duclos disease and Cowden's syndrome in an adolescent patient." Journal of Neurosurgery 81, no. 1 (July 1994): 133–36. http://dx.doi.org/10.3171/jns.1994.81.1.0133.
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✓ Recent reports of seven cases of Lhermitte-Duclos disease occurring in adult patients with Cowden's syndrome (multiple hamartoma syndrome) strongly suggest that Lhermitte-Duclos disease is one of the types of neoplasia that characterize this syndrome. A case of Lhermitte-Duclos disease is reported in a 16-year-old girl with craniomegaly, choroidal hamartoma, and conjunctival papilloma of the right eye, and a history of bilateral multinodular adenomatous goiter and cystic hygroma. These findings strongly suggest a diagnosis of Cowden's syndrome. Although the syndrome traditionally has been defined by mucocutaneous criteria, it typically also involves hamartomas and neoplasia of internal organs, most commonly in the thyroid, breast, and female genitourinary tract. Because the mucocutaneous features may develop several decades after birth, the present case both supports the previously reported association between Lhermitte-Duclos disease and Cowden's syndrome and highlights the need for long-term follow-up monitoring of a pediatric patient with Lhermitte-Duclos disease because of the risk of malignancies associated with Cowden's syndrome.
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Katzman, Ju Hee, Steven Sun, David Joyce, and John Greene. "894. Patient and Surgery Characteristics on Wound Complication and Surgical Site Infection in Sarcoma Patients undergoing Hemipelvectomy." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S481—S482. http://dx.doi.org/10.1093/ofid/ofaa439.1082.
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Abstract Background Hemipelvectomy is associated with a significant risk of wound complications, including infections, bleeding and injuries to nearby neurovascular structures as well as the gastrointestinal and genitourinary tract. This study aimed to determine the patient characteristics and approach to treatment that could affect the occurrence of surgical site infection or wound complications in sarcoma patients undergone hemipelvectomy. Methods We conducted a retrospective analysis of 33 adult patients who underwent hemipelvectomy at Moffitt Cancer Center, Tampa, FL, from 2008 to 2016. We used Chi-square (Exact Fisher) test to investigate the association between wound complication and categorical variables. We used a T-test to evaluate the difference in numerical variables for outcomes. Results Out of 33 patients, 12 (36.4%) patients experienced wound complications after hemipelvectomy (Table 1). The average age of patients with wound complications was 63.3 3 (57.1±15.4) years old, significantly higher than that of patients without wound complications (p=0.004). Without adjustment, the use of computer navigation had a lower wound complication rate (p=0.027). Patients with wound complications had longer hospital length of stay (14.8 vs. 7.0 days, p=0.016). Among patients with surgical site infection (Table 2), there were no patients’ characteristics or surgical characteristics associated with this outcome. Five (15%) patients developed surgical site infection and they had longer hospital stay (19.4 vs. 8.1 days, p=0.001). The organisms identified from wound cultures include methicillin-resistant Staphylococcus aureus, viridans Streptococcus, Peptostreptococcus asaccharolyticus, Enterobacter cloacae, Pseudomonas aeruginosa, Candida albicans. The organisms in late infections (more than 6 months since surgery), included above organisms plus Stenotrophomonas maltophilia and Achromobacter xylosidans. Conclusion Older patients undergoing hemipelvectomy are at an increased risk of developing wound complications with a prolonged hospital stay. Initial antimicrobial therapy for suspected surgical site infection should include a broad-spectrum coverage to include skin and gastrointestinal flora. Disclosures All Authors: No reported disclosures
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Hashibe, Mia, Yuji Chen, Brenna Blackburn, Yuan Wan, Kerry G. Rowe, John Snyder, Vikrant Deshmukh, et al. "Genitourinary disease risks among 5-year ovarian cancer survivors in a population-based cohort study." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 10073. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10073.
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10073 Background: In the US, there are approximately 235,200 ovarian cancer survivors today. Five-year survival for ovarian cancer has increased from 36% for women who were diagnosed in 1975-1977 to 46% for women diagnosed between 2005-2011. Long term follow-up studies among ovarian cancer survivors are uncommon and late effects have not been well characterized in a population-based cohort. Although genitourinary complications during treatment are well known, long term impacts need to be investigated. Methods: A total of 602 first primary invasive ovarian cancer cases diagnosed between 1996-2012 who survived for > 5 years were identified in the Utah Population Database and compared to a general population cohort of women. Genitourinary disease diagnoses were identified through ICD codes from hospital electronic medical records and statewide ambulatory surgery and inpatient data. Cox regression models were used to estimate hazard ratios for disease risks by time since cancer diagnosis with adjustments on matching factors, baseline BMI, baseline Charlson Comorbidity Index (CCI), and race. Results: The overall risk of genitourinary diseases for ovarian cancer patients in comparison to the general population cohort was 1.51 (95%CI = 1.30-1.74) 5-10 years after cancer diagnosis. Approximately 54.6% of ovarian cancer survivors were diagnosed with a genitourinary disease 5-10 years after cancer diagnosis. The most common genitourinary diseases among the ovarian cancer survivors were urinary tract infections (10.1%), acute renal failure (5.5%), and chronic kidney disease (4.4%). The greatest risks were observed for hydronephrosis (HR = 10.65, 95%CI = 3.68-30.80), pelvic peritoneal adhesions (HR = 5.81, 95%CI = 1.11-30.39), cystitis and urethritis (HR = 2.67, 95%CI = 1.21-6.38), and acute renal failure (HR = 2.30, 95%CI = 1.36-3.88). Conclusions: Ovarian cancer survivors experience increased risks of various genitourinary diseases in the 5-10 year period following cancer diagnosis. Understanding the multimorbidity trajectory among ovarian cancer survivors is of vital importance to improve their clinical care after cancer diagnosis and allow for increased attention to these potential late effects.
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Lopukhov, S. V., and E. V. Filippov. "PREMATURE OVARIAN FAILURE, ITS CONSEQUENCES, MORTALITY AND IMPACT ON THE CARDIOVASCULAR SYSTEM." NAUKA MOLODYKH (Eruditio Juvenium) 9, no. 1 (March 31, 2021): 147–56. http://dx.doi.org/10.23888/hmj202191147-156.
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This review focuses on the topic of premature ovarian failure (POF) as highly relevant in modern medicine (up to 2% of women in the population suffer from this disease). However, patients with premature ovarian failure not only are still not receiving any treatment, but even making this diagnosis is very difficult. Even after a correct diagnosis is made, these patients are not followed up, despite the fact they have already developed a hormonal imbalance. These women develop two groups of complications: short-term complications associated with a rapid estrogen deficiency in the body, and much more dangerous long-term complications affecting multiple organs and even systems. But in the meanwhile, women with premature ovarian failure are under increased risk of death from all causes, in particular from coronary heart disease (CHD), respiratory diseases, genitourinary diseases and from external causes. And this is despite the fact that cardio-vascular diseases (CVD) are already the leading cause of death among women worldwide. It is women with POF that are at the highest risk of development of cardiovascular diseases, compared to women with normal menopause. These patients, therefore, constitute one of the most important groups to be targeted by screening and prevention strategies primarily for cardiovascular diseases. These strategies should include the use of risk stratification tools to identify women that need lifestyle modifying and pharmacological therapy to prevent development of such diseases in them. This is the only way to maintain a high quality of life in these women over the long term.
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Sun, Jian, Tania Stafinski, Fernanda Inagaki Nagase, and Devidas Menon. "PP164 Identifying Complications Of Partial Nephrectomy Using Physician Claims." International Journal of Technology Assessment in Health Care 34, S1 (2018): 130–31. http://dx.doi.org/10.1017/s026646231800288x.
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Introduction:Many population-based studies identify surgical complications using hospital discharge abstract databases (DAD). With DAD, however, complications occurring after the discharge date cannot be followed up. This study used physician claims data to identify the complications of partial nephrectomy, and to compare the rates of complications of open, laparoscopic, and robot-assisted nephrectomies.Methods:Physician claims, DAD, and ambulatory care data from April 2003 to March 2016 were provided by Alberta Health. DAD and ambulatory care data were used to extract information on patients with kidney cancer who underwent partial nephrectomy. All physician claims within 30 days before and after surgery for the cohort were extracted. The numbers of the same International Classification of Diseases, Ninth Revision (ICD-9), codes before and after surgery were compared. If a number increased after surgery, this diagnosis was initially identified as a complication. All diagnoses with neoplasms were excluded. The incidence rates of complications for the three surgery groups were calculated. Chi-squared tests were conducted for the following nephrectomy comparisons: laparoscopic versus open; robot-assisted versus open; and robot-assisted versus laparoscopic.Results:A total of 1,890 kidney cancer patients had partial nephrectomies. Among them, 1,080, 411, and 399 had open, laparoscopic, and robot-assisted nephrectomies, respectively. One patient who had two different nephrectomies on the same day was excluded from analysis. The robot-assisted group had lower rates of digestive complications (ICD-9: 537–578, 787, 789, 998.6) and infections (ICD-9: 004–041, 998.5) than the open group, and higher rates of genitourinary complications (ICD-9: 584–599, 788, 997.5) than the laparoscopy group. The robot-assisted group had lower rates than the open group for most of the complication categories, but the differences were not statistically significant.Conclusions:Robot-assisted surgery appears to be superior to open surgery, but no better than laparoscopic surgery, in terms of minimizing the risk of complications following partial nephrectomy.
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Krasilnikov, D. М., I. F. Fatkullin, and O. Y. Karpukhin. "New laser technologies in surgery, obstetrics and gynecology." Kazan medical journal 80, no. 2 (March 25, 1999): 88–90. http://dx.doi.org/10.17816/kazmj65358.
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The ultraviolet laser spectrofluorimetry method for the diagnosis of urgent surgical disrases of abdominal cavity organs and the determination of their vitality is determined. The experimental studies showed the possibility of the use of Nd: YAG-Iaser for sutureless connection of uterus wound edges and geometric recovery of serous integument on the basis of tissue welding. The use of the laser welding suture in the clinic made it possible to decrease by a factor of three the frequency of occurence of pyo-inflammatory complications after caesarean section and uterus supravaginal amputation
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Makarova, K. S., Yu V. Gumenetskaya, V. A. Biryukov, A. A. Obukhov, I. A. Strikanova, S. O. Dzhabrailova, O. G. Lepilina, et al. "Combined modality radiotherapy for high-risk prostate cancer. Analysis of treatment-Related complications." Siberian journal of oncology 18, no. 2 (April 26, 2019): 15–21. http://dx.doi.org/10.21294/1814-4861-2019-18-2-15-21.
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Purpose: to analyze toxicity of combined modality radiotherapy in high-risk prostate cancer patients.Material and methods. Short-term outcomes after combined modality radiotherapy were analyzed in 88 prostate cancer patients treated at clinic of the a.F. tsyb medical Radiological Research center between april 2016 and February 2018. the median follow-up time was 13 months (range, 3–23 months). the mean age of the patients was 64.8 years (range, 49–80 years). an initial psawas in the range of 3.5–114 ng/ml (mean 16.7 ng/ml). all patients were considered high-risk according to the d’amico classification. the patients were divided into two groups according to the sequence of combined modality radiotherapy. in group 1, the patients (n=45) received conformal EBRtto a total dose of 44–46 gy, and 2–3 weeks later, they underwent high–dose rate 192ir- brachytherapy (one single fraction of 15 gy) as a boost to EBRt. in group 2, the patients (n=43) were treated with interstitial brachytherapy followed by EBRtdelivering at total doses of 44–46 gy.Results. All patients eventually completed the combined modality radiotherapy course planned for them. acute, grade 1 genitourinary (gu) toxicities (Rtog/EoRtc) occurred in 29 (32.9 %) patients. acute gastrointestinal (gi) toxicity was grade 1 in 17 (19.3 %) and grade 2 in 2 (2.3 %) patients. late gutoxicity was grade 1 in 6 (6.8 %) and grade 2 in 3 (3.4 %) patients. an urethral stricture developed in 1 (1.1 %) patient. late gitoxicity was grade 1 in 8 (9.1 %) patients and grade 2 in 6 (6.8 %) patients.Conclusion. The preliminary results of this study suggest satisfactory tolerability of combined modality radiotherapy by prostate cancer patients. the level of acute toxicity and complications in critical organs is quite acceptable, which maintains high quality of life for patients and does not exceed the published data.
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Izbick, J. R., C. Bloechle, W. T. Knoefel, D. K. Wilker, G. Dornschneider, H. Seifert, B. Passlick, X. Rogiers, C. Busch, and C. E. Broelsch. "Complications of adjacent organs in chronic pancreatitis managed by duodenum-preserving resection of the head of the pancreas." British Journal of Surgery 81, no. 9 (September 1994): 1351–55. http://dx.doi.org/10.1002/bjs.1800810932.
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