1 / 33

Urological Injuries in OBG Practice: Causes, Symptoms, and Management

This article discusses urological injuries in obstetrics and gynecology practice, including causes, symptoms, intraoperative and postoperative detection methods, investigations, and management options. Prevention strategies are also mentioned to reduce the occurrence of these injuries.

josephvjohnson
Download Presentation

Urological Injuries in OBG Practice: Causes, Symptoms, and Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Urological injuries in OBG Practice DR.H.K.NAGARAJ M.B.B.S., M.S., M.Ch., F.I.C.S., Sr.Prof & Head, Urology Unit-1 M.S.Ramaiah Medical College And Hospital Bangalore-54.

  2. Causes of injuries • Hysterectomy open / Laparascopy – Bladder/ureteric • Caesarian section C. Surgery for endometriosis/PID/Malignancy D. Obstructed Labour-Bladder and urethra E. Anterior Colporraphy F. Sling Surgery

  3. Urological injuries • Bladder injury leading to V.V.F. • Ureteric injuries unilateral leading to ureterovaginal fistula or ureteric stricture • Bilateral ureteral injury leading to uremia/urinary ascites

  4. Symptoms/Presentation • Silent • Haematuria • Urine leak per vagina - immediate / delayed • Fever • Sepsis • Flank pain • Vomiting • Urinary ascites, Ileus

  5. Intraoperative detection • Excessive watery ooze • Routine indigo carmine test • Methylene blue • Role of intra op cystoscopy.

  6. Indigo-Carmine Test

  7. Immediate post-op detection • Urine leak per vagina • Urine leak in the wound • Leukocytosis, azotemia, acidosis • Creatinine levels of the drain fluid

  8. Delayed detection • Hydroureteronephrosis • Nonfunctioning kidney • Urinary fistulae

  9. Investigations • Ultrasound scan of abdomen • I.V.U. X ray • CT with contrast • Antegrade Nephrostogram • Retrograde Ureterogram • MCU • Cystoscopy & methylene blue test

  10. USG showing hydroureteronephrosis secondary to ureteric stricture

  11. CT urogram

  12. Retrograde ureterogram

  13. Antegrade Nephrostogram

  14. MCU

  15. Cystoscopy

  16. Management • D.J.Stenting • End to end anastomosis • Ureteric reimplantation • Psoas hitch/boari flap • Ileal ureter • V.V.F. Repair

  17. D J Stenting

  18. End to End anastomosis

  19. Ureteric Reimplantation

  20. Psoas hitch

  21. Boari flap • Tongue shaped flap from the Urinary Bladder • Ureter is anastomosed to the tubularised bladder flap over a DJ stent

  22. V.V.F. repair

  23. Early laparoscopic repair for supratrigonal vesicovaginal fistulaInternational Gynaecology JournalJuly 2007, Volume 18, Issue 7, pp 759-762 HK Nagaraj , TA Kishore et al • Laparoscopic repair undertaken 2-4 wks after initial surgery. – Excellent outcomes

  24. A Simplified Laparoscopic Approach to Repair Vesicovaginal Fistula: The M.S. Ramaiah TechniqueTarun Dilip Javali, Amit Katti, and Harohalli K. NagarajUROLOGY 85: 544e546, 2015

  25. Prevention • Exposure to urinary tract • Ureteric catheter insertion • Use weck clips • Stay close to uterus • Prevent lateral tear of uterus during caesarian • Put a drain-when in doubt • Keep partially full bladder • Use large size catheters to drain bladder • Do bed side U/s abd

  26. Thank you

More Related