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Nephrectomy and partial nephrectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Imran Mushtaq, Alberto Mantovani, Judy Hung Wing Suet
A retroperitoneal urinoma can occur from the reflux of urine from the distal ureteric stump or from the cut surface of the kidney following heminephrectomy. The risk can be kept to a minimum by the use of the energy devices on the renal parenchyma and by endoloop ligation of refluxing ureters as opposed to the use of hemoclips or an energy device to seal the ureter. Most urinomas will resolve with the placement of a urethral catheter for at least 48–72 hours. A persistent urine leak or an infected urinoma may require the placement of a percutaneous wound drain. Theoretically, with the RP approach the urinoma should be confined and resolve more rapidly compared with TP surgery, where the peritoneal cavity could allow the leak to drain for longer.
Elements of Case Analysis
Published in Julie Dickinson, Anne Meyer, Karen J. Huff, Deborah A. Wipf, Elizabeth K. Zorn, Kathy G. Ferrell, Lisa Mancuso, Marjorie Berg Pugatch, Joanne Walker, Karen Wilkinson, Legal Nurse Consulting Principles and Practices, 2019
Tonia Aiken, Phyllis ZaiKaner Miller, Marguerite Barbacci
A 47-year-old stay-at-home mother had a long history of painful uterine fibroid tumors and very heavy menstrual periods. She was prescribed iron supplements but remained anemic, which interfered with her ability to run marathons. The potential plaintiff sought definitive treatment and consented to undergo a hysterectomy as recommended by her gynecologist. The surgeon determined that an abdominal hysterectomy was the best option due to the likelihood of encountering pelvic adhesions from prior cesarean sections and other abdominal surgeries. The surgery was completed “without complication,” as documented by the surgeon in the operative report. On post-operative day three, the patient’s abdomen was distended, and she complained of severe abdominal pain. An ileus was suspected due to decreased bowel sounds and inability to pass flatus. Laxatives were prescribed, and ambulation encouraged. On post-operative day four, the patient was febrile with no discernible bowel sounds. A CT scan of the abdomen was performed and revealed an urinoma. The patient was returned to the operating room for an exploratory laparotomy, which revealed a severed right ureter. Surgical repair of the ureter was completed and included the placement of a percutaneous nephrostomy tube to drain urine from the kidney while the ureter healed. The patient was discharged home three days after her repair surgery with instructions to return for the removal of the nephrostomy tube in six weeks. Subsequent testing revealed normal kidney function with a functional right ureter.
Urologic Considerations in Colorectal Surgery
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Garrett Friedman, Julio Garcia-Aguilar
Urinoma is a chronic collection of extravasated urine. Most urinomas are sterile and often diagnosed by a bulge in the abdominal wall. They can occasionally get infected, causing symptoms indistinguishable from an abscess. They are often diagnosed by abdominal and pelvic CT scan. Treatment is by drainage in the first instance and management of the cause for definitive resolution.
Bilateral same session flexible ureterorenoscopy for endoscopic management of bilateral renal calculi is noninferior to unilateral flexible ureterorenoscopy for management of multiple unilateral renal calculi: outcomes of a prospective comparative study
Published in Scandinavian Journal of Urology, 2022
Indraneel Banerjee, Abhishek Bhat, Jonathan E. Katz, Rashmi H. Shah, Nicholas Anthony Smith, Hemendra N. Shah
The postoperative complications were comparable in both the groups. One patient in the control group developed perirenal urinoma that was incidentally detected on postoperative ultrasound and managed conservatively. Complete SFR after the first procedure was 78.5% in the U-FURS arm and 67.85% in the BSS-FURS arm, respectively (p = 0.436). Patients in whom the procedure was abandoned due to tight ureter, the outcome from the second procedure was considered while calculating SFR. If we incorporate the patients who had <3 mm residual fragments as stone free also, the SFR increases to 87.5% in the BSS-FURS arm as compared to 91.07% in the U-FURS arm. The details of retreatment are provided in Table 2. The stone compositions were similar and there was no significant rise in the postoperative serum creatinine in both the groups.
Fibrin glue as a sealant in stentless laparoscopic pyeloplasty: A randomised controlled trial
Published in Arab Journal of Urology, 2019
Ahmed Farouk, Ahmed Tawfick, Mahmoud Reda, Ahmed M. Saafan, Waleed Mousa, Ahmed M. Tawfeek, Hassan Shaker
In the early postoperative period, no significant difference was found for postoperative pain, amount and duration of leakage, time to drain removal, and hospital stay. Nevertheless, the number of patients that had prolonged urinary leakage was more than double in the no fibrin group vs the fibrin group (10 and 24 patients, respectively), which was highly statistically significantly different (P = 0.002). From those, urinary leakage occurred in five patients in Group A and 12 patients in Group B in the immediate postoperative period, but did not last for >5 days. Prolonged leakage continued for of >5 days in three patients (7.14%) in Group A and six (14.3%) in Group B, which stopped spontaneously before the end of 14 days, a statistically insignificant difference (P = 0.265). Additionally, two (4.3%) and five patients (10.9%), in groups A and B respectively, developed a persistent leak for 14 days. This was again statistically insignificant (P = 0.434). All patients with persistent leakage were managed by inserting a JJ stent, except in one child aged 3.5 years in Group B, who was managed by nephrostomy due to failure of applying the JJ stent. One patient in Group B, a 9-year-old child, developed urinoma a week after he was discharged. He was managed by nephrostomy and pigtail catheter drainage. Finally, one patient in Group B developed a deep venous thrombosis (Table 2).
Robotic stone surgery – Current state and future prospects: A systematic review
Published in Arab Journal of Urology, 2018
Philippe F. Müller, Daniel Schlager, Simon Hein, Christian Bach, Arkadiusz Miernik, Dominik S. Schoeb
To date, the treatment of ureteric stones with a diameter >2 cm remains challenging. Most guidelines recommend URS with intracorporeal stone disintegration or extracorporeal SWL for the localisation of these stones [16]. However, laparoscopic surgery for impacted ureteric stones is considered a suitable alternative [28]. In 2013, Dogra et al. [29] published, to their knowledge, the first clinical experience with a da Vinci system for this type of stone. From 2010 to 2012, they performed robot-assisted ureterolithotomy in 16 patients and reported no conversions to open surgery. Retrospectively, they observed no major postoperative complications or the development of urinoma. They also reported a stone clearance rate of 100% and compared to classic laparoscopic surgery the hospital stay was shorter. The placed intra-abdominal drain could be removed after a mean of 18 h. In an average follow-up of 13 months, they did not report ureteric strictures after removing the JJ stent at 4 weeks after surgery. However, their study had some limitations; it was retrospective with a small number of patients. Nevertheless, the presented data showed robot-assisted ureterolithotomy to be, at least, an acceptable alternative to laparoscopic approaches. More prospective studies with a comparison with standard-of-care procedures, such as URS and SWL, are necessary to evaluate the benefits of the robotic approach.