A retrospective review of 120 patients diagnosed to have lower genito-urinary fistulae, over a period of 42 years, was performed. The patients were seen at the University Maternity Hospital or the Zahrawi Maternity Hospital, Damascus, Syria. The majority of the patients, particularly in the early part of this period, had obstetrical causes (90.5%), mainly due to obstructed labour, difficult and traumatic forceps deliveries, ruptured uterus and bladder and/or lower segment caesarean section (LSCS). Less frequently encountered gynecological causes, in the same early period, were due to total abdominal hysterectomy (TAH), Wertheim radical hysterectomy (WRH), anterior vaginal repair, sling operation and other causes (9.5%). However, in the later part of this study, the main causes became gynecological (57%) with obstetric causes contributing in only 43% of the cases. Urinary fistulae still represent a major problem in Syria and reflect a sub-optimal level of training of undergraduate and post-graduate students and poor socio-economic conditions. The overall cure rate was 77%. It is hoped that with better hospital care, improvement in the quality of medical practice and the socio-economic status in the country, the incidence of genito-urinary fistulae will be reduced. (+info)
An unusual case of a ureteric hernia into the sciatic foramen causing urinary sepsis: successfully treated laparoscopically.
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We present the rare case of a ureteric hernia into the sciatic foramen. The presentation was that of a 59-year-old woman with urinary tract sepsis associated with an acute deterioration of renal function. The hernia was successfully repaired laparoscopically. (+info)
Last resort for renal transplant recipients, 'restored kidneys' from living donors/patients.
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Laparoscopic ureteral reimplant for distal ureteral strictures.
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BACKGROUND AND OBJECTIVES: The incidence of ureteral injuries is on the rise. Endoscopic treatment of long distal ureteral strictures is associated with poor success rates, and open ureteral reimplantation is a potentially morbid surgical procedure. The objective of this study was to review our early results with laparoscopic ureteral reimplantation. METHODS: Between May 2004 and February 2007, 6 patients with ureteral strictures secondary to either gynecological surgery (4) or urolithiasis (2) presented for treatment. These patients failed traditional conservative treatment and underwent laparoscopic ureteral reimplantation. RESULTS: Five of the 6 cases were performed completely laparoscopically, while one patient had an elective open conversion to complete the vesicoureteral anastomosis. No major intraoperative or postoperative complications were encountered. The mean operating room time was 277 minutes (range, 180 to 360). The average hospital stay was 2.7 days (range, 2 to 5). All patients had a successful outcome defined as no evidence of radiographic obstruction and no clinical complaints of persistent renal colic. Mean follow-up was 13.2 months (range, 2 to 33). CONCLUSION: Our early results demonstrate that laparoscopic ureteral reimplantation is an effective minimally invasive treatment option for distal ureteral strictures. (+info)
Giant megaureters presenting as a multicystic abdominal mass.
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Megaureter is a developmental anomaly of the ureter, which is associated with significant morbidity in children and frequently requires surgical intervention. I am presenting here a case of massively dilated ureters in a child that occupied almost the entire abdomen and was wrongly misinterpreted as a cystic lymphangioma due to its unusual presentation. (+info)
Donor nephrectomy with and without preservation of gonadal vein while dissecting the ureter.
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INTRODUCTION: Preservation of the gonadal vein while dissecting the ureter for donor nephrectomy may decrease the distal ureteral ischemia and urological complications in kidney transplant recipients. In this study, we compared the outcome of kidney allografts harvested with preservation of the gonadal vein while dissecting the ureter with allografts harvested without preserving the gonadal vein. MATERIALS AND METHODS: We reviewed 167 consecutive kidney transplantations between April 2003 and April 2004. During donor nephrectomy, we preserved the gonadal vein in 106 harvested kidneys (group 1), while we did not preserve this vein in 61 allografts (group 2). The recipients in each group were followed up for a 2-year follow-up on average, and the outcomes including ureteral complications, graft loss, and patient and graft survival were compared between the two groups. RESULTS: Urine leakage was noted in few patients (2 in group 1 and 3 in group 2) and its frequency was not significantly different between the two groups (P = .26). Ureteral stricture was not seen in any of the kidney allograft recipients. No differences were found in the frequencies of acute rejection episodes, graft loss, and death between the two groups. CONCLUSION: Preservation of the gonadal veins did not significantly decrease the frequency of ureteral complications in the kidney transplant recipients. We recommend meticulous handling of the ureter in donor nephrectomies to prevent further remote complications regardless of the approach to the gonadal veins while nephrectomy. (+info)
Use of ileum as ureteral replacement in urological reconstruction.
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