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Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
In planning treatment, relevant factors include the size and location of the stone, the degree of obstruction, the severity of symptoms, and the presence of infection. Most calculi will pass spontaneously with hydration. If necessary, minimally invasive treatment options, such as ureteral stent placement, ureteroscopic retrieval, or percutaneous nephrostomy, may be considered (86). These procedures have been safely performed throughout pregnancy (87–89). Open ureterolithotomy is rarely required. Extracorporeal shock-wave lithotripsy has not been approved for use during pregnancy. Unless severe infection complicates the course of urolithiasis, a good perinatal outcome is expected.
Complications of inferior vena cava filters
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Matthew T. Major, Paul G. Bove, Graham W. Long
IVC perforation is defined as a filter strut or anchor extending > 3 mm outside the vessel wall and entering the retroperitoneum or surrounding anatomic structures (Figures 12.5–12.7). The majority are asymptomatic, and some suggest filter perforation may be more common than previously estimated. In a literature review of IVC filters, caval perforation was reported in 19% of 9002 reviewed cases. Among the cases of filter perforation, 8% were symptomatic. For symptomatic patients, pain was most commonly reported (77%); 5% had major complications requiring unplanned intervention, which included surgical removal of the IVC filter (63), endovascular stent graft placement for aortic pseudoaneurysm (8), endovascular retrieval of permanent filter (4), arterial embolization for bleeding (2), endovascular stent graft with embolization (1), percutaneous nephrostomy (1), ureteral stent placement (1), and percutaneous nephrostomy with ureteral stent (1). Perforated struts involved other organs or anatomic structures 19% of the time, with the duodenum, lumbar vertebra, and aorta being the most commonly affected. Less common presentations reported in the literature include pancreatitis, ureteral injury, retroperitoneal hematoma, and chronic pain syndrome.15
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Urinary retention may result depending on the level of obstruction within the urinary tract. The most common conditions causing an obstruction include urolithiasis and benign prostatic hypertrophy. Alongside pain relief and fluid resuscitation of the patient, an obstruction can lead to hydronephrosis eventually causing significant renal injury. Relief of the back pressure is imperative to prevent permanent damage from occurring, and this may be carried out through catheterisation, stent insertion or a nephrostomy.
Cumulative incidence of ureteroenteric strictures after radical cystectomy in a population-based Swedish cohort
Published in Scandinavian Journal of Urology, 2021
Jenny Magnusson, Oskar Hagberg, Firas Aljabery, Abolfazl Hosseini, Staffan Jahnson, Tomas Jerlström, Amir Sherif, Karin Söderkvist, Viveka Ströck, Anders Ullén, Christel Häggström, Lars Holmberg, Henrik Kjölhede
A weakness is the composite endpoint which may lead to both false positive events, e.g. in the case of placing a nephrostomy tube due to normal post-cystectomy CT-findings with hydronephrosis, and false negative results, e.g. if a patient was censored due to urolithiasis before a stricture occurred. Furthermore, there is no procedure code for removal of a nephrostomy tube, so whether this was a permanent or temporary procedure could not be determined. To adjust for the risk of overestimating or underestimating the incidence of strictures we separately analysed the subgroup with codes indicating stricture and intervention and the subgroup diagnosed with hydronephrosis but not followed by an intervention. In most other series the endpoint is intervention for stricture but this might lead to underestimating the incidence of strictures since some patients do not undergo intervention due to co-morbidity or high age.
Emergency vs elective ureteroscopy for a single ureteric stone
Published in Arab Journal of Urology, 2021
Abdullatif Al-Terki, Majd Alkabbani, Talal A. Alenezi, Tariq F. Al-Shaiji, Shabir Al-Mousawi, Ahmed R. El-Nahas
The most common presentation of ureteric calculi is acute renal colic. This severe pain episode urges the patient to seek medical advice immediately [1] and it is a leading urological cause of emergency department visits [2]. Management of acute renal colic secondary to ureteric calculi starts with analgesics to control pain [3]. If analgesics fail to control pain or there are complications of obstruction, such as fever or acute kidney injury, upper tract drainage with a nephrostomy tube or ureteric stent is required [4]. Elective treatment modalities for ureteric calculi include medical expulsive therapy (MET), extracorporeal shockwave lithotripsy (SWL), and ureteroscopy (URS). The choice of a certain treatment depends on the patient’s presentation, comorbidities, renal and stone characteristics, availability of instruments, and surgeon experience [5].
64 MS-CTU: Review of techniques and spectrum of the ureteric diseases
Published in Alexandria Journal of Medicine, 2018
Ureteric injuries are more commonly iatrogenic; most commonly during gynaecological procedures. Penetrating or blunt ureteric injuries are relatively uncommon; representing <1% of all urological trauma. Anatomically, ureteric injury could be classified into pelviureteric - upper third ureter (mostly due to blunt abdominal trauma and RTA), middle and distal thirds ureteric trauma, which is often following iatrogenic injury. CTU with intravenous contrast is the examination of choice for evaluation of ureteric trauma, as it clearly demonstrates the site and the extent of the injury. Also, it can accurately verify its type; whether avulsion or trans-section or ligation. In addition to its role in detection of associated other abdominal organ injuries and the resultant complications e.g. retroperitoneal hematoma, hydronephrosis, strictures and the resultant obstructive nephropathy ending if neglected into renal failure. Early diagnosis and appropriate correction of the cause- if possible- (e.g. removal of suture on tied ureter or reconstruction of induced ureteric strictures) will result in satisfactory outcome. Temporary ureteric stents or even percutaneous nephrostomy may be needed until full ureteric repair is done.37