Our Summary

This research paper discusses a rare case involving a 53-year-old man who had undergone a specific type of bypass surgery. Four months after the operation, he began to experience severe blood in his urine. After examining him, doctors discovered that the graft (the piece of tissue used in the bypass) had accidentally been placed in a way that it was injuring the wall of his bladder.

This type of injury during vascular surgery is extremely unusual. In fact, according to existing scientific literature, only 11 such cases have ever been reported.

The doctors were able to fix the problem by removing the misplaced graft and reconstructing the bypass with a silver-coated prosthesis made of a material called Dacron.

The paper suggests that, despite the rarity of this complication, it’s a good idea to perform an ultrasound of the bladder after this kind of surgery. This will allow any injuries to be detected early on and the right surgical strategy to be implemented.

FAQs

  1. What is an extra-anatomic right-to-left iliofemoral bypass graft?
  2. How common are iatrogenic bladder injuries during vascular surgery?
  3. What is the recommended postoperative procedure to detect any bladder injury?

Doctor’s Tip

A doctor may advise a patient undergoing bladder surgery to follow postoperative care instructions carefully, including avoiding strenuous activities, staying hydrated, and taking prescribed medications as directed. It is also important to attend all follow-up appointments to monitor healing and address any concerns promptly.

Suitable For

Patients who may be recommended bladder surgery include those with:

  • Bladder cancer
  • Bladder outlet obstruction (such as from an enlarged prostate)
  • Urinary incontinence
  • Interstitial cystitis
  • Bladder stones
  • Neurogenic bladder (due to conditions such as spinal cord injury or multiple sclerosis)
  • Bladder diverticulum
  • Bladder prolapse

It is important for patients to undergo a thorough evaluation by a urologist to determine the most appropriate treatment option for their specific condition.

Timeline

  • Patient undergoes extra-anatomic right-to-left iliofemoral bypass graft surgery
  • 4 months post-surgery, patient develops gross hematuria
  • Cystoscopic examination reveals wall injury caused by the graft crossing the bladder
  • Misplaced graft is removed and bypass reconstructed with silver-coated Dacron prosthesis
  • Postoperative ultrasound of the bladder is recommended for timely detection of any injury and appropriate surgical intervention.

What to Ask Your Doctor

  1. What type of bladder surgery will be performed and why is it necessary?

  2. What are the potential risks and complications associated with the surgery?

  3. What is the expected recovery time and what can I do to promote healing?

  4. Will I need to make any lifestyle changes or follow any special instructions after the surgery?

  5. How will the surgery affect my bladder function and urinary habits?

  6. Are there any alternative treatments or less invasive options that could be considered?

  7. How experienced are you in performing this type of surgery?

  8. What is the success rate of this surgery for my specific condition?

  9. What should I expect in terms of pain management and post-operative care?

  10. Are there any long-term effects or considerations I should be aware of after the surgery?

Reference

Authors: Vincenzoni C, Sica S, Natola M, Sacco E, Totaro A, Bassi P, Tshomba Y. Journal: Ann Vasc Surg. 2019 Aug;59:307.e13-307.e16. doi: 10.1016/j.avsg.2019.02.045. Epub 2019 May 7. PMID: 31075468