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Dr. Andrew Rynne

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What causes bleeding from the urethra post ureteroscopy?

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Dr. Matthew J. Mangat

Urologist

Practicing since :1981

Answered : 1886 Questions

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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?
doctor
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
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