Our Summary

This research paper discusses a new way of fixing a type of injury that can occur during gynecological surgery, specifically, damage to the ureter (a tube that carries urine from the kidneys to the bladder). This kind of injury often happens during a procedure to remove the uterus (hysterectomy), but can also occur during cesarean section surgeries. In this paper, the authors present a technique for repairing this injury in patients who still have their uterus intact, using a robot-assisted surgery.

The paper explains the steps taken to assess and surgically treat a patient who had this sort of injury, which was not immediately recognized, during a cesarean section. The standard surgical procedure had to be modified to suit a patient with an intact uterus. This involved moving the uterus, dividing a ligament, moving the bladder, developing a space behind the pubic bone, and reattaching the ureter.

The authors conclude that with a few simple changes, the standard robot-assisted surgical procedure can effectively repair this type of injury in women who still have their uterus. They suggest that doctors should be vigilant for this type of injury in women who experience severe urinary leakage after a cesarean section.

FAQs

  1. What is the technique used for delayed robotic-assisted ureteral reimplant and psoas hitch in women with ureteral injury during a cesarean section?
  2. What modifications are made to the traditional technique of robotic-assisted ureteroneocystotomy to accommodate an intact uterus?
  3. What signs should obstetricians look for in women post-cesarean section to suspect ureteral injury?

Doctor’s Tip

One helpful tip a doctor might tell a patient about ureteral reimplantation is to follow post-operative instructions carefully, including avoiding heavy lifting and strenuous activity to allow the ureter to heal properly. It is also important to stay hydrated and follow up with your doctor for any signs of infection or complications.

Suitable For

Patients who may be recommended for ureteral reimplantation include those with ureteral injuries sustained during gynecological surgeries such as hysterectomy or cesarean section, as well as individuals with congenital abnormalities or strictures affecting the ureter. These patients may present with symptoms such as urinary leakage, recurrent urinary tract infections, or hydronephrosis. Additionally, patients with a history of pelvic radiation therapy or previous failed attempts at ureteral reconstruction may also be candidates for ureteral reimplantation.

Timeline

  • Before ureteral reimplantation: The patient may present with symptoms such as new-onset severe urinary leakage post-cesarean section, indicating a possible ureteral injury. The injury may be initially diagnosed as a uretero-cervical fistula. Evaluation and imaging studies are performed to confirm the diagnosis and determine the extent of the injury.

  • During ureteral reimplantation: The patient undergoes robotic-assisted laparoscopic ureteroneocystostomy and psoas hitch. Modifications are made to the traditional technique to accommodate the presence of an intact uterus. This includes uterine manipulation, division of the round ligament, bladder mobilization from the lower uterine segment, development of the retropubic space, reimplantation steps, and psoas hitch.

  • After ureteral reimplantation: The patient is monitored closely for postoperative complications and to ensure proper healing of the ureteral reimplantation site. Follow-up appointments and imaging studies may be scheduled to assess the success of the procedure and the patient’s recovery. Symptoms of urinary leakage should improve following the surgery, and the patient should experience relief from any preoperative symptoms related to the ureteral injury.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with ureteral reimplantation surgery?
  2. How long is the recovery process expected to be after ureteral reimplantation surgery?
  3. What is the success rate of ureteral reimplantation surgery in cases like mine?
  4. Will I need to follow any specific post-operative care instructions after the surgery?
  5. Are there any alternative treatment options available for my condition?
  6. How experienced are you in performing ureteral reimplantation surgeries?
  7. What can I expect in terms of long-term outcomes after undergoing ureteral reimplantation surgery?
  8. Will I need any additional tests or procedures before the surgery?
  9. How soon after the surgery can I expect to see an improvement in my symptoms?
  10. Are there any lifestyle changes I should consider making to support the success of the surgery?

Reference

Authors: Smith W, Dutta R, Matthews C. Journal: Int Urogynecol J. 2021 Oct;32(10):2867-2870. doi: 10.1007/s00192-020-04627-4. Epub 2021 Jan 6. PMID: 33404800