Sam Siddighi1,2, Junchan J Yune3, Nicole B Kwon4, Jeffrey S Hardesty4, Joo H Kim5, Philip J Chan6. 1. Female Pelvic Medicine and Reconstructive Surgery, Loma Linda University School of Medicine, 11234 Anderson St., Coleman Suite 11105, Loma Linda, CA, 92345, USA. ssiddighi@llu.edu. 2. , 11350 Anderson St., Suite 3900, Loma Linda, CA, USA. ssiddighi@llu.edu. 3. Urology Department, Loma Linda University School of Medicine, 11234 Anderson St., Coleman Suite 11105, Loma Linda, CA, 92354, USA. 4. Female Pelvic Medicine and Reconstructive Surgery, Loma Linda University School of Medicine, 11234 Anderson St., Coleman Suite 11105, Loma Linda, CA, 92345, USA. 5. Loma Linda University School of Medicine, 11234 Anderson St., Loma Linda, CA, 92354, USA. 6. Gynecology and Obstetrics Department, Loma Linda University School of Medicine, 11370 Anderson St., Suite 3950, Loma Linda, CA, 92354, USA.
Abstract
PURPOSE: To illustrate a simple method that screens for ureteral injury in the acute postoperative period after urogynecologic surgeries. METHODS: Serum creatinine measurements in the preoperative (baseline) and postoperative periods of urogynecologic surgeries were determined and the correlation of the change to ureteral injury and/or obstruction analyzed. The sample size calculation showed 7 cases and 28 controls were sufficient to detect significant changes in creatinine. Each of the seven cases was matched for age and type of surgery with a control patient in a 1:4 ratio following standard protocol. RESULTS: Chart review of patients (273 cases) undergoing urogynecologic surgeries from October 2009 to June 2014 were undertaken. There were 7 cases of ureteral injury and 28 matching control cases. All cases had intraoperative cystoscopy confirming bilateral ureteral flow. In the ureteral injury group, blockage of ureter was confirmed by CT scan with IV contrast. There was a 59.8% increase in serum creatinine levels postoperative in the ureteral injury group versus a 3.8% decrease in controls. A difference of creatinine levels greater than or equal to 0.3 mg/dL over baseline was evident in ureteral injury cases. CONCLUSION: A small change in serum creatinine level over baseline after urogynecologic surgery alerted the possibility of ureteral injury or obstruction. A simple and inexpensive evaluation of perioperative creatinine levels can promptly diagnose ureteral damage in the acute postoperative period for gynecologic reconstructive surgeries.
PURPOSE: To illustrate a simple method that screens for ureteral injury in the acute postoperative period after urogynecologic surgeries. METHODS: Serum creatinine measurements in the preoperative (baseline) and postoperative periods of urogynecologic surgeries were determined and the correlation of the change to ureteral injury and/or obstruction analyzed. The sample size calculation showed 7 cases and 28 controls were sufficient to detect significant changes in creatinine. Each of the seven cases was matched for age and type of surgery with a control patient in a 1:4 ratio following standard protocol. RESULTS: Chart review of patients (273 cases) undergoing urogynecologic surgeries from October 2009 to June 2014 were undertaken. There were 7 cases of ureteral injury and 28 matching control cases. All cases had intraoperative cystoscopy confirming bilateral ureteral flow. In the ureteral injury group, blockage of ureter was confirmed by CT scan with IV contrast. There was a 59.8% increase in serum creatinine levels postoperative in the ureteral injury group versus a 3.8% decrease in controls. A difference of creatinine levels greater than or equal to 0.3 mg/dL over baseline was evident in ureteral injury cases. CONCLUSION: A small change in serum creatinine level over baseline after urogynecologic surgery alerted the possibility of ureteral injury or obstruction. A simple and inexpensive evaluation of perioperative creatinine levels can promptly diagnose ureteral damage in the acute postoperative period for gynecologic reconstructive surgeries.
Entities:
Keywords:
Creatinine; Surgery injury; Ureter; Urogynecology
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