Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

170 Doctors Online
Doctor Image
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

What causes bleeding from the urethra post ureteroscopy?

Answered by
Dr. Matthew J. Mangat


Practicing since :1981

Answered : 1886 Questions

Posted on Mon, 3 Aug 2015 in Urinary and Bladder Problems
Question: Hi,

please note that i have a Case of a patient who was admitted for Ureteroscopy and laser treatment with DJ Stenting under GA and during the procedure a complication occurred (Ureter Avulsion). i have quoted the operative notes written by the doctor below.

Operative notes:
Cystoscope was passed. Right ureter orifice negotiated with guide wire then ureteroscope introduced over the sensor wire. There were multiple strictures on the right ureter wall all were dilated to reach the stone which was then engaged and broken to pieces. While retrieving back the ureteroscope ureter avulsion injury occurred then XXXXXXX invusion made. Peritoneum retracted and retroperitoneum exposed, upper ureter and bladder exposed.
Avulsion part pulled through the bladder and anastomosis made with upper ureter and trigone anastomosis done over the DJ Stent. Drains passed and catheter inserted and wound closed in layers.
Catheter in place
Right and left drains in situ
Blood loss is 300 ml

Please note that the patient is suffering from this for more than 14 days post the surgery with complication, bleeding from the urethra and on suprapubic catheter. Urine culture was done and the result was out on 03/07/2015 which was positive for Pseudomonas Aeurginosa and hence the patient was started on Colistin 1 million units TDS

kindly let me know your expert opinion on the following:
You kind opinion on the approach of the surgery?
What would be done better over here?
Is there any way to avoid this complication which was not done?
Is it a common complication?
Answered by Dr. Matthew J. Mangat 38 minutes later
Brief Answer:
Ureteroscopic lithotripsy is the correct surgery.

Detailed Answer:
Hello and welcome to HCM.
Your concern is understandable. As an Urologist, i'll try to answer your doubts.
The approach to surgery is a routine one for stones in ureter.
Avulsion is a known complication of this surgery, but uncommon.
The multiple strictures inside the ureter should be the cause for this complication.
What's the cause for theese strictures , only your Urologist can tell you.
Retrospectively, leaving the stone without treating it, is not an option, that any Urologist would consider.

Hope your doubts are cleared. Feel free to contact me anytime.
Wishing you a speedy recovery.
Above answer was peer-reviewed by : Dr. Vaishalee Punj

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions
Medical Procedures
Medical Topics ,   ,  

Recent questions on  Avulsion injury

doctor1 MD

I have been told there is a chance I have a tiny fracture in the top of my tibia and that if I continue to use my leg for weight bearing activity, the tibia may spread apart causing permanent damage requiring surgery and 6 months in a cast. This...

doctor1 MD

can anyone tell me what this letter mean? There's a small calcific density at the tip of the medical malleolus which may represent sequela from a avulsion injury . There is a large inferior calcaneal spur and a small retrocalcaneal enthesophye....

doctor1 MD

Hi there, I sprained my ankle and chipped the nevicular bone in my foot (avulsion injury) when descending stairs over a week ago. I have tubi-grip on my foot 24hours a day but received no further advice from emergency medical staff e.g. prognosis , pain-killers and rest / exercise periods. Any advice would be much appreciated.

doctor1 MD

I have a 15 year old severe brachial plexus injury . Surgery was performed almost a year after the accident due to the doc on call the night I was rushed to ER decided to wait and see. I ended up having surgery to remove scar tissue and try to fix any nerves and nerve roots intact. It was noted that I have avulsion of 4 nerve roots. I have developed CRPS Type II on top of the awful pain from the BP injury among several other injuries. I recently found out that I have full thickness scarring in the brachial plexus and my ROM has declined significantly. My question is this. Is there any way a doctor would consent to a surgery to remove the scar tissue again to help relieve some of the horrific pain I have and possibly improve ROM. I know removing scar tissue is a temporary step as it will grow back. But if it gives me even a few weeks/months of decreased pain, I would do it in a heartbeat . As it stand now I am almost debilitating pain 24 hours a day. My pain meds, 3 SGNB gmhave done nothing. Acupuncture , massage, biofeedback, guided imagery, TENS unit, chiropractor etc have done nothing to help. They may have made it worse.