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Simon Horenblas - One of the best experts on this subject based on the ideXlab platform.

  • Urological complications after treatment of cervical cancer
    Nature Reviews Urology, 2014
    Co-Authors: Simon Horenblas
    Abstract:

    In the past two decades, improvements to the techniques of radical hysterectomy and chemoradiotherapy for the treatment of cervical cancer have led to a reduction in the associated urological complications. This Review considers the prevalence of lower urinary tract dysfunction in the era of nerve-sparing surgery and decreased radiation fields. Several urological complications can occur after treatment of cervical cancer. Stage IB and IIA cervical tumours are mainly treated by radical hysterectomy; advanced-stage tumours are treated by chemoradiotherapy. In the past two decades, a decrease in complications has been seen due to improvements in therapy, although the exact incidence of lower urinary tract dysfunction is unknown. The main urological complications after radical surgery are hypocontractility of the Bladder, detrusor overactivity, incontinence, low-compliance Bladder, Fistula and hydronephrosis. As a result of improved neuroanatomical knowledge, and consequently nerve-sparing surgery, Bladder morbidity has been decreasing. Late radiation-induced urological complications include haemorrhagic cystitis, ureteric stenosis, low-compliance Bladder and Fistulas. Owing to technological improvements, such as dose reduction and decreased radiation fields, a decrease in radiation morbidity has been observed since 1990. The exact incidence of lower urinary tract dysfunction after treatment of cervical cancer is not known, but it has decreased in the past two decades Frequently occurring urological disorders after radical surgery are hypocontractility of the Bladder, detrusor overactivity, incontinence and low-compliance Bladder Neuroanatomical knowledge and concomitant nerve-sparing surgery are essential to reduce lower urinary tract dysfunction after radical hysterectomy Radiation-induced urological complications include radiation cystitis, ureteric stenosis, fibrotic, shrunken, low-compliance Bladder and Fistula formation Owing to the development of image-guided radiotherapy, fewer radiation-induced urological complications have been reported since 1990

Dong Ik Song - One of the best experts on this subject based on the ideXlab platform.

  • vesicocutaneous Fistula presenting groin abscess and chronic osteomyelitis in pubic bone
    Clinics in Orthopedic Surgery, 2009
    Co-Authors: Woong Kyo Jung, Dong Ik Song
    Abstract:

    The authors report a case of Bladder Fistula associated with a medial thigh cutaneous Fistula and chronic osteomyelitis of the pubic bone 11 years after surgery for a pelvic bone fracture and Bladder rupture. In the presenting case, despite the clinical suspicion, none of the diagnostic tools demonstrated the Bladder Fistula preoperatively. This case suggests that Bladder repair should be prepared, even if the Bladder Fistula cannot be confirmed by imaging studies because the amount of urine leakage can be minimal or the Fistula can close spontaneously.

Georgia Panagopoulos - One of the best experts on this subject based on the ideXlab platform.

  • urodynamic characteristics of mixed urinary incontinence and idiopathic urge urinary incontinence
    Neurourology and Urodynamics, 2008
    Co-Authors: Eric Chiehlung Chou, Jerry G Blaivas, Liwei Chou, Adam J Flisser, Georgia Panagopoulos
    Abstract:

    Purpose: To evaluate and compare the clinical and urodynamic findings in patients with either mixed urinary incontinence (MUI) or simple urge urinary incontinence (UUI). Materials and Methods: A series of 100 consecutive female patients with MUI and UUI were identified from a database. Patients with neurogenic Bladder, Fistula, urethral diverticulum, prior urologic surgery or known urinary tract obstruction were excluded. All patients were classified according to the urodynamic classification of overactive Bladder of Flisser et al. and all patients underwent history, physical examination, validated incontinence questionnaire, 24-hour voiding diary, 24-hour pad test, video urodynamic study (VUDS), and cystoscopy. Results: A significantly higher proportion of patients with UUI exhibited detrusor overactivity at VUDS, (67% of the patients with UUI vs. 24% of the MUI, P < 0.05). Patients with UUI had fewer episodes of incontinence (6.7 vs. 4.2, P < 0.05) with slightly less objective urine loss (24-hour pad test 94 gm vs. 128 g of loss, P < 0.05) and voided at higher pressures (pdet at Qmax 21.4 vs. 15.6 cm H2O, P < 0.05). Patients in both groups had functional and urodynamic Bladder capacities that were not statistically different. Conclusions: Women with UUI were more likely to exhibit detrusor overactivity but experienced fewer episodes of incontinence and less urinary loss when compared with women who had MUI. The ‘‘urge incontinence’’ component of MUI appears to be different than that of UUI, and suggests that urge incontinence may be overdiagnosed in patients with SUI who misinterpret their fear of leaking (because of SUI) for urge incontinence. Neurourol. Urodynam. 27:376–378, 2008. 2008 Wiley-Liss, Inc.

Emi C Bretschneider - One of the best experts on this subject based on the ideXlab platform.

  • timing of diagnosis of complex lower urinary tract injury in the 30 day postoperative period following benign hysterectomy
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Douglas Luchristt, Oluwateniola Brown, Julia Geynismantan, Margaret G Mueller, Kimberly Kenton, Emi C Bretschneider
    Abstract:

    BACKGROUND Complex lower urinary tract injury (cLUTI) resulting from hysterectomy is a rare but highly morbid complication. While intraoperative recognition reduces risk of serious sequelae, observational studies have shown that the majority of cLUTI are recognized in the postoperative period. To date, limited research exists describing the timing of cLUTI diagnosis or risk factors associated with cLUTI diagnosed in the postoperative period. OBJECTIVES This analysis aimed to describe the time to diagnosis of cLUTI among women undergoing benign hysterectomy. We also aimed to identify intraoperative risk factors for differences in type and timing of cLUTI in the 30-day postoperative period using a large prospective national surgical database. STUDY DESIGN This was a retrospective analysis using the National Surgical Quality Improvement Program (NSQIP) hysterectomy dataset from 2014-2018. All benign hysterectomies were included. Sociodemographic factors, health status, surgeon type and other operative characteristics were extracted. A cLUTI was defined as at least one ureteral obstruction, ureteral Fistula or Bladder Fistula diagnosed within the first 30 days following surgery. Bivariate and multivariate logistic regression and cox proportional hazards assessed differences in odds of and time until diagnosis of cLUTI. Proportional hazard assumptions were evaluated with martingale residuals and Supremum tests. Significance thresholds were 0.05 for all analyses. RESULTS 100,823 women met inclusion criteria. Median time to cLUTI diagnosis was 10 days (IQR 3-19) and varied significantly based on type of injury (P<0.01) with ureteral obstruction (6, IQR 2-16) recognized earlier than ureteral Fistula (12, IQR 7-21) and Bladder Fistula (14, IQR 4-23). 8.65% of cLUTI were diagnosed on the day of surgery. Total laparoscopic hysterectomy had the lowest rate of cLUTI in unadjusted and adjusted analysis, with abdominal hysterectomy and vaginal hysterectomy having greater odds of ureteral obstruction (aOR 2.02, CI 1.21-3.36 and aOR 2.05, CI 1.16-3.62) while laparoscopic assisted vaginal hysterectomy had the greatest odds of Fistula (aOR 2.10, CI 1.26-3.48). Concomitant apical suspension was associated with a 6-day reduction in median time to diagnosis (P= 0.01) and surgery with a gynecologic oncologist associated with a 9.5-day increase in median time to diagnosis (P=0.01). Cox proportional hazards analysis confirmed these findings when controlling for confounders. CONCLUSIONS Greater than 91% of cLUTI diagnoses in the NSQIP hysterectomy database were diagnosed after the day of surgery. Route of hysterectomy, concomitant apical suspension and primary surgeon specialty are significantly associated with differences in both type of injury and time until diagnosis. These intraoperative risk factors should be considered when assessing for cLUTI in the 30-day postoperative period.

Douglas Luchristt - One of the best experts on this subject based on the ideXlab platform.

  • timing of diagnosis of complex lower urinary tract injury in the 30 day postoperative period following benign hysterectomy
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Douglas Luchristt, Oluwateniola Brown, Julia Geynismantan, Margaret G Mueller, Kimberly Kenton, Emi C Bretschneider
    Abstract:

    BACKGROUND Complex lower urinary tract injury (cLUTI) resulting from hysterectomy is a rare but highly morbid complication. While intraoperative recognition reduces risk of serious sequelae, observational studies have shown that the majority of cLUTI are recognized in the postoperative period. To date, limited research exists describing the timing of cLUTI diagnosis or risk factors associated with cLUTI diagnosed in the postoperative period. OBJECTIVES This analysis aimed to describe the time to diagnosis of cLUTI among women undergoing benign hysterectomy. We also aimed to identify intraoperative risk factors for differences in type and timing of cLUTI in the 30-day postoperative period using a large prospective national surgical database. STUDY DESIGN This was a retrospective analysis using the National Surgical Quality Improvement Program (NSQIP) hysterectomy dataset from 2014-2018. All benign hysterectomies were included. Sociodemographic factors, health status, surgeon type and other operative characteristics were extracted. A cLUTI was defined as at least one ureteral obstruction, ureteral Fistula or Bladder Fistula diagnosed within the first 30 days following surgery. Bivariate and multivariate logistic regression and cox proportional hazards assessed differences in odds of and time until diagnosis of cLUTI. Proportional hazard assumptions were evaluated with martingale residuals and Supremum tests. Significance thresholds were 0.05 for all analyses. RESULTS 100,823 women met inclusion criteria. Median time to cLUTI diagnosis was 10 days (IQR 3-19) and varied significantly based on type of injury (P<0.01) with ureteral obstruction (6, IQR 2-16) recognized earlier than ureteral Fistula (12, IQR 7-21) and Bladder Fistula (14, IQR 4-23). 8.65% of cLUTI were diagnosed on the day of surgery. Total laparoscopic hysterectomy had the lowest rate of cLUTI in unadjusted and adjusted analysis, with abdominal hysterectomy and vaginal hysterectomy having greater odds of ureteral obstruction (aOR 2.02, CI 1.21-3.36 and aOR 2.05, CI 1.16-3.62) while laparoscopic assisted vaginal hysterectomy had the greatest odds of Fistula (aOR 2.10, CI 1.26-3.48). Concomitant apical suspension was associated with a 6-day reduction in median time to diagnosis (P= 0.01) and surgery with a gynecologic oncologist associated with a 9.5-day increase in median time to diagnosis (P=0.01). Cox proportional hazards analysis confirmed these findings when controlling for confounders. CONCLUSIONS Greater than 91% of cLUTI diagnoses in the NSQIP hysterectomy database were diagnosed after the day of surgery. Route of hysterectomy, concomitant apical suspension and primary surgeon specialty are significantly associated with differences in both type of injury and time until diagnosis. These intraoperative risk factors should be considered when assessing for cLUTI in the 30-day postoperative period.

  • Timing of diagnosis of complex lower urinary tract injury in the 30-day postoperative period following benign hysterectomy.
    American Journal of Obstetrics and Gynecology, 2020
    Co-Authors: Douglas Luchristt, Oluwateniola Brown, Margaret G Mueller, Kimberly Kenton, Julia Geynisman-tan, C. Emi Bretschneider
    Abstract:

    BACKGROUND Complex lower urinary tract injury (cLUTI) resulting from hysterectomy is a rare but highly morbid complication. While intraoperative recognition reduces risk of serious sequelae, observational studies have shown that the majority of cLUTI are recognized in the postoperative period. To date, limited research exists describing the timing of cLUTI diagnosis or risk factors associated with cLUTI diagnosed in the postoperative period. OBJECTIVES This analysis aimed to describe the time to diagnosis of cLUTI among women undergoing benign hysterectomy. We also aimed to identify intraoperative risk factors for differences in type and timing of cLUTI in the 30-day postoperative period using a large prospective national surgical database. STUDY DESIGN This was a retrospective analysis using the National Surgical Quality Improvement Program (NSQIP) hysterectomy dataset from 2014-2018. All benign hysterectomies were included. Sociodemographic factors, health status, surgeon type and other operative characteristics were extracted. A cLUTI was defined as at least one ureteral obstruction, ureteral Fistula or Bladder Fistula diagnosed within the first 30 days following surgery. Bivariate and multivariate logistic regression and cox proportional hazards assessed differences in odds of and time until diagnosis of cLUTI. Proportional hazard assumptions were evaluated with martingale residuals and Supremum tests. Significance thresholds were 0.05 for all analyses. RESULTS 100,823 women met inclusion criteria. Median time to cLUTI diagnosis was 10 days (IQR 3-19) and varied significantly based on type of injury (P