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Related Concept Videos

Urinary Tract Calculi I: Introduction01:28

Urinary Tract Calculi I: Introduction

Renal calculi, or kidney stones, are solid deposits of minerals and salts formed inside the kidneys. In medical terminology, "calculus" refers to the stone itself, while "lithiasis" describes the process of stone formation. Depending on their location within the urinary system, these stones may be classified as either urolithiasis, when situated within the urinary tract, or nephrolithiasis, when located within the kidneys. Each term signifies the specific impact of the stone.Predisposition...
Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations01:26

Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations

Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
Urinary Tract Calculi III: Medical Management01:30

Urinary Tract Calculi III: Medical Management

The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
Urinary Tract Calculi V: Nursing Management01:28

Urinary Tract Calculi V: Nursing Management

AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
Imaging Studies V: Intravenous Urography and Retrograde Pyelography01:22

Imaging Studies V: Intravenous Urography and Retrograde Pyelography

IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...

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Ureteric Injury During Gynaecological Surgery - Lessons from 20 Cases in Canada.

G P Jacob1, G A Vilos2, F Al Turki3

  • 1Department of Obstetrics and Gynecology, Chatham-Kent Health Alliance, Chatham, Ontario, Canada.

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Summary

Ureteric injury during gynecological surgery is linked to obesity and prior surgeries. Delayed diagnosis and surgical conduct impact patient outcomes and surgeon litigation.

Keywords:
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Area of Science:

  • Gynecological Surgery
  • Urology
  • Medical Malpractice

Background:

  • Ureteric injury is a significant complication of gynecological surgery, leading to patient morbidity and litigation.
  • Identifying risk factors and outcomes is crucial for improving patient care and legal defense.

Purpose of the Study:

  • To determine patient characteristics, peri-operative circumstances, and clinical/legal outcomes of ureteral injuries during benign gynecological surgery.
  • To identify factors correlating with poor clinical and legal outcomes after ureteric injury.

Main Methods:

  • Retrospective review of 20 cases of ureteric injury during benign gynecological surgery.
  • Assessment of patient characteristics, surgical indications, injury details, postoperative symptoms, and clinical/legal outcomes.

Main Results:

  • Risk factors included obesity, prior pelvic surgery, adhesions, large masses, and bleeding.
  • 70% of injuries were diagnosed post-discharge; 50% had complicated postoperative courses.
  • 45% of cases resulted in unfavorable legal outcomes for the surgeon, often due to surgical conduct or delayed postoperative management.

Conclusions:

  • Intra-operative consultation and ureteral identification are recommended when ureteral involvement is suspected.
  • Reasonable peri-operative care can mitigate negligence claims for ureteric injury.