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Ureteric injury in gynaecological practice — A 12 year experience
MONDAY,
SEPTEMBER
4
P1.19.14
URETERIC INJURY IN GYNAECOLOGICAL PRACTICE -A 12 YEAR EXPERIENCE. Begum, Dept OBIGYN, Dhaka Medical College and Hospital Dhaka 1000, Bangladesh, F. Dept OBIGYN, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh, R. Begum, Dept OBIGYN, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh Objectives: Our purpose was to review and analyze ureteric injuries incidental to surgical procedure. Study methods: Data were collected prospectively by authors over 12 years. Seventeen patients were observed and treated during this period. Among them 5 patients were diagnosed in the hospital and 12 patients were referred from outside. Operation was performed in the hospital according to type of injury. All patients were followed up for 3 months. At the end of 3’d month intravenous orography was done in every case to assess kidney function. Results: Procedures resulting in ureteric injury were Total abdominal hysterectomy 11 (64.70%), Wertheim’s hysterectomy 1 (5.88%), Caeserean Section 3 (17.64%), removal of residual ovarian mass 1 (5.88%) and repair of vesicovaginal fistula 1 (5.88%). Indications of Total abdominal hysterectomy were Endometriosis 4 (36.36%), Pelvic inflammatory disease 2 (18.18%), Fibroid uterus 3 (27.27%) and Dysfunctional uterine bleeding 2 (18.18%). Injuries were diagnosed during parent operation in 3 cases and others by clinical examination, examination under anaesthesia and intravenous orography. Ureter0 neocystostomy was performed in 14 (82.35%) cases and end to end anastomosis were performed in 3 (17.64%) cases. All patients were cured and no renal damage was found after 3 months by IVU. Conclusions: Ureteric injury during Gynaecological or Obstetrical surgery is not very common. Though it is a serious complication, management is not difficult and prognosis is satisfactory.
P1.19.15
ENDOSCOPIC SLING OPERATION IN THE TREATMENT FOR RECURRENT GENUINE STRESS INCONTINENCE T. H. So, .I. P. Huang, Y. L. Wang, .I. M. Yang, Urodynamic Unit, Dept. of OBIGYN, Mackay Memorial Hospital, Taipei, Taiwan. Objectives: To evaluate the techniques and results of endoscopic sling operation in the treatment for recurrent genuine stress incontinence. Study Methods: Forty two patients with urodynamically proven recurrent GSI were recruited in this study. They were treated by a modified endoscopic needle urethropexy technique which employed a Gore-Tex as a sling to support the bladder neck. The outcome of surgery was evaluated both subjectively and objectively. Results: The cure rate of endoscopic sling operation was 88.1% by objective assesment, and 92.9%, subjectively. Increased maximal urethral closure pressure and minimal urethral resistance were noted in success group but not in failure group. The complication rate was 26.2 % including de nova DI (14.3%), tissue erosion (7.1%), wound infection (4.8%), prolonged urine retention (2 7days, 14.3%) and UT1 (9.5%). Conclusions: Based on the results of the study, we believe the endoscopic sling operation is promising for treatment of recurrent GSI. However, some failure cases were still present in our series. Further study is needed to investigate and clarify the causes of failure, and to reduce the complication rate.
143
P1.19.16 VALIDITY OF A SPECIFIC QUESTIONNAIRE CONCERNING URINARY PROBLEMS AND QUALITY OF LIFE AMONG THE FEMININE POPULATION OF THE CANARY ISLANDS (SPAIN) M.A. Pascual (la), O.Y. Marco (la), M.J. Rodriguez (lb), A.I. MCndez
(lc), A.I. Padilla (la), F. Diez (Id), A. Jimenez (lb), A. Monga (2), J. Parache (la) (l)Dept. OBIGYN, University Hospital Canaries, Canary Islands, Spain. a-Dept. Research Unit, University Hospital Canaries, Canary b-Islands, Spain. c-Nursing Dept., University Hospital Canaries, Canary Islands, Spain. d-Primary Care, University Hospital Canaries, Canary Islands, Spain. (2)Princess Ann Hospital, Southamptom, UK Objectives: To verify if the specific King Health Questionnaire Version 7.0 (KHQ) which assesses the impact on the quality of life of urinary problems, can be a good tool to detect urinary incontinence among the feminine adult population. Study Methods: Cross-section study of the population. The KHQ has been translated and adapted to our setting, the Island of Tenerife (Canary Islands) among 70 randomly chosen women of a wide range of age and socio-economic background. We first proceeded to check and establish the concordance between the auto-administrative questionnaire and the interview. The validity of the questionnaire has been obtained by using as Gold Standard the Pad test for one hour, validated by ICS with 42 women of different ages (18-85) with and without incontinence, including a 10% of each category depending on the perception of the problem. These persons were selected through a random sample of 466 women who had previously fulfilled the questionnaire by means of interviews. Results: The Kappa index of concordance between the autoadministrative version and the interviews s of 70%. The questionnaire has a sensitivity (S) of a 90% and a specificity (SP) of 80% in order to detect mixed urinary incontinence (diagnosis by symptoms). The sensitivity and specificity of the questionnaire is higher for urge incontinence (S=90%, SP=80%) as for the one related to stress (S=70%, SP=44%). Conclusion: The Spanish version of the KHQ, culturally adapted to the Canary Islands has more credibility if obtained through a personal interview, and it is a good tool to detect urinary incontinence in adult women.
P1.19.17 SURGICAL REPAIR OF VESICO-VAGINAL FISTULAE IN PAKISTAN S. Pushua, Dept. OBIGYN, Liaquat Medical College Hospital,
Hyderabad,
Pakistan.
Objectives: In developing nations the Vesico-Vaginal fistulae generally result from neglected obstructive labor or as a complication of pelvic surgery. We have reviewed the results of VVF closure carried out by simple method of dissection and suturing, over a period of 3 years. Study Methods: This was the retrospective study. The records of 40 women with VVF managed in our department from 1996 to 1999 were scrutinized. 36 patients had fistulae due to ischaemic necrosis as a result of obstructed labor and in remaining 7 patients’ pelvic surgery was responsible. Results: All patients were operated by simple dissection and suturing method. 38 (95%) were operated vaginally and 2 (5%) through abdominal transvaginal route. 36 (90%) fistulae were successfully corrected on first attempt. 4 recurred after primary closure including two that recurred even after second attempt and left the follow up. Conclusion: VVF resulting from obstructed labor or surgical trauma can be successfully managed by simple method of dissection and suturing preferably by vaginal route. Adequate exposures, wide mobilization of vaginal flaps over site of fistulae and tension free closure are the keys to success.
SEPTEMBER
4
P1.19.14
URETERIC INJURY IN GYNAECOLOGICAL PRACTICE -A 12 YEAR EXPERIENCE. Begum, Dept OBIGYN, Dhaka Medical College and Hospital Dhaka 1000, Bangladesh, F. Dept OBIGYN, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh, R. Begum, Dept OBIGYN, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh Objectives: Our purpose was to review and analyze ureteric injuries incidental to surgical procedure. Study methods: Data were collected prospectively by authors over 12 years. Seventeen patients were observed and treated during this period. Among them 5 patients were diagnosed in the hospital and 12 patients were referred from outside. Operation was performed in the hospital according to type of injury. All patients were followed up for 3 months. At the end of 3’d month intravenous orography was done in every case to assess kidney function. Results: Procedures resulting in ureteric injury were Total abdominal hysterectomy 11 (64.70%), Wertheim’s hysterectomy 1 (5.88%), Caeserean Section 3 (17.64%), removal of residual ovarian mass 1 (5.88%) and repair of vesicovaginal fistula 1 (5.88%). Indications of Total abdominal hysterectomy were Endometriosis 4 (36.36%), Pelvic inflammatory disease 2 (18.18%), Fibroid uterus 3 (27.27%) and Dysfunctional uterine bleeding 2 (18.18%). Injuries were diagnosed during parent operation in 3 cases and others by clinical examination, examination under anaesthesia and intravenous orography. Ureter0 neocystostomy was performed in 14 (82.35%) cases and end to end anastomosis were performed in 3 (17.64%) cases. All patients were cured and no renal damage was found after 3 months by IVU. Conclusions: Ureteric injury during Gynaecological or Obstetrical surgery is not very common. Though it is a serious complication, management is not difficult and prognosis is satisfactory.
P1.19.15
ENDOSCOPIC SLING OPERATION IN THE TREATMENT FOR RECURRENT GENUINE STRESS INCONTINENCE T. H. So, .I. P. Huang, Y. L. Wang, .I. M. Yang, Urodynamic Unit, Dept. of OBIGYN, Mackay Memorial Hospital, Taipei, Taiwan. Objectives: To evaluate the techniques and results of endoscopic sling operation in the treatment for recurrent genuine stress incontinence. Study Methods: Forty two patients with urodynamically proven recurrent GSI were recruited in this study. They were treated by a modified endoscopic needle urethropexy technique which employed a Gore-Tex as a sling to support the bladder neck. The outcome of surgery was evaluated both subjectively and objectively. Results: The cure rate of endoscopic sling operation was 88.1% by objective assesment, and 92.9%, subjectively. Increased maximal urethral closure pressure and minimal urethral resistance were noted in success group but not in failure group. The complication rate was 26.2 % including de nova DI (14.3%), tissue erosion (7.1%), wound infection (4.8%), prolonged urine retention (2 7days, 14.3%) and UT1 (9.5%). Conclusions: Based on the results of the study, we believe the endoscopic sling operation is promising for treatment of recurrent GSI. However, some failure cases were still present in our series. Further study is needed to investigate and clarify the causes of failure, and to reduce the complication rate.
143
P1.19.16 VALIDITY OF A SPECIFIC QUESTIONNAIRE CONCERNING URINARY PROBLEMS AND QUALITY OF LIFE AMONG THE FEMININE POPULATION OF THE CANARY ISLANDS (SPAIN) M.A. Pascual (la), O.Y. Marco (la), M.J. Rodriguez (lb), A.I. MCndez
(lc), A.I. Padilla (la), F. Diez (Id), A. Jimenez (lb), A. Monga (2), J. Parache (la) (l)Dept. OBIGYN, University Hospital Canaries, Canary Islands, Spain. a-Dept. Research Unit, University Hospital Canaries, Canary b-Islands, Spain. c-Nursing Dept., University Hospital Canaries, Canary Islands, Spain. d-Primary Care, University Hospital Canaries, Canary Islands, Spain. (2)Princess Ann Hospital, Southamptom, UK Objectives: To verify if the specific King Health Questionnaire Version 7.0 (KHQ) which assesses the impact on the quality of life of urinary problems, can be a good tool to detect urinary incontinence among the feminine adult population. Study Methods: Cross-section study of the population. The KHQ has been translated and adapted to our setting, the Island of Tenerife (Canary Islands) among 70 randomly chosen women of a wide range of age and socio-economic background. We first proceeded to check and establish the concordance between the auto-administrative questionnaire and the interview. The validity of the questionnaire has been obtained by using as Gold Standard the Pad test for one hour, validated by ICS with 42 women of different ages (18-85) with and without incontinence, including a 10% of each category depending on the perception of the problem. These persons were selected through a random sample of 466 women who had previously fulfilled the questionnaire by means of interviews. Results: The Kappa index of concordance between the autoadministrative version and the interviews s of 70%. The questionnaire has a sensitivity (S) of a 90% and a specificity (SP) of 80% in order to detect mixed urinary incontinence (diagnosis by symptoms). The sensitivity and specificity of the questionnaire is higher for urge incontinence (S=90%, SP=80%) as for the one related to stress (S=70%, SP=44%). Conclusion: The Spanish version of the KHQ, culturally adapted to the Canary Islands has more credibility if obtained through a personal interview, and it is a good tool to detect urinary incontinence in adult women.
P1.19.17 SURGICAL REPAIR OF VESICO-VAGINAL FISTULAE IN PAKISTAN S. Pushua, Dept. OBIGYN, Liaquat Medical College Hospital,
Hyderabad,
Pakistan.
Objectives: In developing nations the Vesico-Vaginal fistulae generally result from neglected obstructive labor or as a complication of pelvic surgery. We have reviewed the results of VVF closure carried out by simple method of dissection and suturing, over a period of 3 years. Study Methods: This was the retrospective study. The records of 40 women with VVF managed in our department from 1996 to 1999 were scrutinized. 36 patients had fistulae due to ischaemic necrosis as a result of obstructed labor and in remaining 7 patients’ pelvic surgery was responsible. Results: All patients were operated by simple dissection and suturing method. 38 (95%) were operated vaginally and 2 (5%) through abdominal transvaginal route. 36 (90%) fistulae were successfully corrected on first attempt. 4 recurred after primary closure including two that recurred even after second attempt and left the follow up. Conclusion: VVF resulting from obstructed labor or surgical trauma can be successfully managed by simple method of dissection and suturing preferably by vaginal route. Adequate exposures, wide mobilization of vaginal flaps over site of fistulae and tension free closure are the keys to success.