Cystosufflation to prevent bladder injury.
نویسنده
چکیده
STUDY OBJECTIVE This brief report will share information about the use and safety of inflating the bladder with carbon dioxide to delineate the margins during laparoscopic dissections near the bladder in patients who have scarring, adhesions, or challenging anatomy. DESIGN A retrospective chart review of patients undergoing total or radical laparoscopic hysterectomy, or support procedures from September 5, 1996, through October 30, 2008, was conducted. Canadian Task Force level III. SETTING Community hospital. PATIENTS Of 1004 patients having simple or radical laparoscopic hysterectomy or laparoscopic support procedures, cystosufflation was used in 173 patients. Indications included finding of adhesions from earlier cesarean section or massive myomas obscuring bladder margins, or planned anterior colpopexy or vaginal sacrocolpopexy. INTERVENTIONS Cystosufflation uniformly entailed the following: clamping of the bladder catheter with a Kelly clamp; connection of the laparoscopic carbon-dioxide insufflation tubing to the catheter; then under direct laparoscopic observation, release of the Kelly clamp with immediate bladder inflation revealing the cystic margins. MEASUREMENTS AND MAIN RESULTS Cystosufflation safely facilitated the dissection of the bladder off the anterior cervix and vagina, or off the anterior abdominal wall. Distention of the bladder elevated and rounded up the bladder margins so that the muscularis could be clearly identified, preventing bladder injury in all patients. No urologic complications occurred in these cases. CONCLUSION These retrospective data suggest that cystosufflation is well tolerated by patients and can reliably prevent cystotomy.
منابع مشابه
SUPRA VESICAL DIVERSION AND LATER UNDIVERSION IN SEVERE WAR INJURIES OF THE BLADDER
From 20 patients with bladder injury due to war trauma, three patients were in critical condition because of extensive bladder injury associated with rectosigmoid injury and septicemia. In these three patients, early supravesical diversion was undertaken using ileal conduit. After stabilization of the patients' condition, undiversion was performed successfully, bringing the patients back t...
متن کاملPreventing Bladder Injury at Hysterectomy in Post-Cesareans
With the increasing cesarean section rates gynecologists are facing more number of cases with previously scarred uterus at the time of hysterectomy. Uterine incision especially of cesarean section leads to bladder adhesions which poses great problem at the time of bladder dissection during hysterectomy and sometimes inadvertently ends up in cystostomy. Greater the number of cesareans, higher is...
متن کاملChanges in Urinary Bladder Structure and Systemic Inflammation Response Following Incomplete Transection versus Contusion Spinal Cord Injury in Rat Model
Objective- The current study was conducted to evaluate changes in the urinary bladder structure and leukocyte profile as an important index of the systemic inflammation response for two different types of spinal cord injury (SCI) in a rat model. Design- Experimental Study.Animals- Forty adult healthy female Sprague-Dawley rats.<br /...
متن کاملIntraoperative bladder perforation during primary total hip arthroplasty
We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature. These factors include cemented acetabul...
متن کاملPathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury
Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activa...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of minimally invasive gynecology
دوره 16 2 شماره
صفحات -
تاریخ انتشار 2009