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Functional Outcomes of Bladder Reconstruction Secondary to Trauma and Ureteral Injury

  • Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
  • Published:
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Abstract

Injury to the ureter and bladder are relatively rare occurrences and provoke significant diagnostic dilemmas. Etiologies include external trauma, such as automobile accidents or gunshot wounds, and iatrogenic injuries during pelvic surgery or endoscopy. When lower urinary tract injury goes unrecognized, presenting symptoms can be vague and often delay diagnosis. Such delays may result in prolonged hospital stays and deterioration of renal function and have significant impact on a patient’s quality of life. Reconstruction of these injuries can be challenging depending on the mechanism and location of injury. Overall functional outcomes of reconstruction for ureteral or bladder injuries is excellent, but there is limited data on post-operative voiding function. One unique injury worth mentioning is mesh erosion into the genitourinary tract where patients may have persistent lower urinary tract symptoms after reconstruction.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Shilo Y et al. Evaluation of the tensile strength of the human ureter—preliminary results. J Endourol. 2014;28(12):1470–3.

    Article  PubMed  Google Scholar 

  2. Haider AH et al. Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact? J Am Coll Surg. 2012;214(5):756–68.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Shewakramani S, Reed KC. Genitourinary trauma. Emerg Med Clin North Am. 2011;29(3):501–18.

    Article  PubMed  Google Scholar 

  4. Deibert CM, Spencer BA. The association between operative repair of bladder injury and improved survival: results from the National Trauma Data Bank. J Urol. 2011;186(1):151–5.

    Article  PubMed  Google Scholar 

  5. Pereira BM et al. A review of ureteral injuries after external trauma. Scand J Trauma Resusc Emerg Med. 2010;18:6.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Siram SM et al. Ureteral trauma: patterns and mechanisms of injury of an uncommon condition. Am J Surg. 2010;199(4):566–70.

    Article  PubMed  Google Scholar 

  7. Elliott SP, McAninch JW. Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital. J Urol. 2003;170(4 Pt 1):1213–6.

    Article  PubMed  Google Scholar 

  8. Brandes S et al. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int. 2004;94(3):277–89.

    Article  PubMed  Google Scholar 

  9. Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urol Clin N Am. 2006;33(1):55–66. vi.

    Article  Google Scholar 

  10. Bariol SV et al. An analysis of urinary tract trauma in Scotland: imnpact on management and resource needs. Surgeon. 2005;3(1):27–30.

    Article  CAS  PubMed  Google Scholar 

  11. Bjurlin MA et al. Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma. 2009;67(5):1033–9.

    Article  PubMed  Google Scholar 

  12. Gomez RG et al. Consensus statement on bladder injuries. BJU Int. 2004;94(1):27–32.

    Article  PubMed  Google Scholar 

  13. Pereira BM et al. Bladder injuries after external trauma: 20 years experience report in a population-based cross-sectional view. World J Urol. 2013;31(4):913–7.

    Article  PubMed  Google Scholar 

  14. Hsieh CH et al. Diagnosis and management of bladder injury by trauma surgeons. Am J Surg. 2002;184(2):143–7.

    Article  PubMed  Google Scholar 

  15. Udekwu PO, Gurkin B, Oller DW. The use of computed tomography in blunt abdominal injuries. Am Surg. 1996;62(1):56–9.

    CAS  PubMed  Google Scholar 

  16. Tezval H et al. Urinary tract injuries in patients with multiple trauma. World J Urol. 2007;25(2):177–84.

    Article  PubMed  Google Scholar 

  17. Avey G et al. Radiographic and clinical predictors of bladder rupture in blunt trauma patients with pelvic fracture. Acad Radiol. 2006;13(5):573–9.

    Article  PubMed  Google Scholar 

  18. Wirth GJ et al. Advances in the management of blunt traumatic bladder rupture: experience with 36 cases. BJU Int. 2010;106(9):1344–9.

    Article  PubMed  Google Scholar 

  19. Dobrowolski Z et al. Renal and ureteric trauma: diagnosis and management in Poland. BJU Int. 2002;89(7):748–51.

    Article  CAS  PubMed  Google Scholar 

  20. Klap J et al. Aetiology and management of iatrogenic injury of the ureter: a review. Prog Urol. 2012;22(15):913–9.

    Article  CAS  PubMed  Google Scholar 

  21. Cordon BH, Fracchia JA, Armenakas NA. Iatrogenic nonendoscopic bladder injuries over 24 years: 127 cases at a single institution. Urology. 2014;84(1):222–6.

    Article  PubMed  Google Scholar 

  22. Selzman AA, Spirnak JP. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol. 1996;155(3):878–81.

    Article  CAS  PubMed  Google Scholar 

  23. Ostrzenski A, Radolinski B, Ostrzenska KM. A review of laparoscopic ureteral injury in pelvic surgery. Obstet Gynecol Surv. 2003;58(12):794–9.

    Article  PubMed  Google Scholar 

  24. Parpala-Sparman T et al. Increasing numbers of ureteric injuries after the introduction of laparoscopic surgery. Scand J Urol Nephrol. 2008;42(5):422–7.

    Article  PubMed  Google Scholar 

  25. Dowling RA, Corriere Jr JN, Sandler CM. Iatrogenic ureteral injury. J Urol. 1986;135(5):912–5.

    CAS  PubMed  Google Scholar 

  26. Lucarelli G et al. Delayed relief of ureteral obstruction is implicated in the long-term development of renal damage and arterial hypertension in patients with unilateral ureteral injury. J Urol. 2013;189(3):960–5.

    Article  PubMed  Google Scholar 

  27. Einstein MH et al. Quality of life in cervical cancer survivors: patient and provider perspectives on common complications of cervical cancer and treatment. Gynecol Oncol. 2012;125(1):163–7.

    Article  PubMed  Google Scholar 

  28. Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol. 2006;107(6):1366–72.

    Article  CAS  PubMed  Google Scholar 

  29. Mendez LE. Iatrogenic injuries in gynecologic cancer surgery. Surg Clin N Am. 2001;81(4):897–923.

    Article  CAS  PubMed  Google Scholar 

  30. Saguan D et al. Iatrogenic lower urinary tract injury at the time of pelvic reconstructive surgery: does previous pelvic surgery increase the risk? Int Urogynecol J. 2014;25(8):1041–6.

    Article  PubMed  Google Scholar 

  31. Lord HE et al. A randomized controlled equivalence trial of short-term complications and efficacy of tension-free vaginal tape and suprapubic urethral support sling for treating stress incontinence. BJU Int. 2006;98(2):367–76.

    Article  PubMed  Google Scholar 

  32. Porena M et al. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol. 2007;52(5):1481–90.

    Article  PubMed  Google Scholar 

  33. Andonian S et al. Randomized clinical trial comparing suprapubic arch sling (SPARC) and tension-free vaginal tape (TVT): one-year results. Eur Urol. 2005;47(4):537–41.

    Article  PubMed  Google Scholar 

  34. Hammad FT, Kennedy-Smith A, Robinson RG. Erosions and urinary retention following polypropylene synthetic sling: Australasian survey. Eur Urol. 2005;47(5):641–6. discussion 646-7.

    Article  CAS  PubMed  Google Scholar 

  35. Richter HE et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362(22):2066–76.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Osborn DJ et al. Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation. Int J Urol. 2014;21(11):1167–70.

    Article  PubMed  Google Scholar 

  37. Davila GW, Jijon A. Managing vaginal mesh exposure/erosions. Curr Opin Obstet Gynecol. 2012;24(5):343–8.

    Article  PubMed  Google Scholar 

  38. Andersen P, Andersen LM, Iversen LH. Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches. Surg Endosc. 2015;29(6):1406–12.

    Article  PubMed  Google Scholar 

  39. Halabi WJ et al. Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum. 2014;57(2):179–86.

    Article  PubMed  Google Scholar 

  40. de la Rosette J et al. The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol. 2014;28(2):131–9.

    Article  PubMed  Google Scholar 

  41. Reyes JM et al. Delayed proximal ureteric stricture formation after complex partial nephrectomy. BJU Int. 2012;109(4):539–43.

    Article  PubMed  Google Scholar 

  42. Blaivas JG, Mekel G. Management of urinary fistulas due to midurethral sling surgery. J Urol. 2014;192(4):1137–42. This is the first case series reporting on urinary fistulas due to midurethral sling surgery.

    Article  PubMed  Google Scholar 

  43. Kromann B et al. The use of the Boari-flap and psoas-bladder hitch technique in the repair of a high ureteric lesion. A case report. Scand J Urol Nephrol. 1986;20(3):233–4.

    Article  CAS  PubMed  Google Scholar 

  44. Riedmiller H et al. Psoas-hitch ureteroneocystostomy: experience with 181 cases. Eur Urol. 1984;10(3):145–50.

    CAS  PubMed  Google Scholar 

  45. Ahn M, Loughlin KR. Psoas hitch ureteral reimplantation in adults—analysis of a modified technique and timing of repair. Urology. 2001;58(2):184–7.

    Article  CAS  PubMed  Google Scholar 

  46. Mathews R, Marshall FF. Versatility of the adult psoas hitch ureteral reimplantation. J Urol. 1997;158(6):2078–82.

    Article  CAS  PubMed  Google Scholar 

  47. Mauck RJ et al. Central role of Boari bladder flap and downward nephropexy in upper ureteral reconstruction. J Urol. 2011;186(4):1345–9.

    Article  PubMed  Google Scholar 

  48. Motiwala HG, Shah SA, Patel SM. Ureteric substitution with Boari bladder flap. Br J Urol. 1990;66(4):369–71.

    Article  CAS  PubMed  Google Scholar 

  49. Olsson CA, Norlen LJ. Combined Boari bladder flap-psoas bladder hitch procedure in ureteral replacement. Scand J Urol Nephrol. 1986;20(4):279–84.

    Article  CAS  PubMed  Google Scholar 

  50. Konigsberg H, Blunt KJ, Muecke EC. Use of Boari flap in lower ureteral injuries. Urology. 1975;5(6):751–5.

    Article  CAS  PubMed  Google Scholar 

  51. Manassero F et al. Ureteral reimplantation with psoas bladder hitch in adults: a contemporary series with long-term followup. Sci World J. 2012;2012:379316.

    Article  Google Scholar 

  52. Thompson IM, Ross Jr G. Long-term results of bladder flap repair of ureteral injuries. J Urol. 1974;111(4):483–7.

    CAS  PubMed  Google Scholar 

  53. Berzeg S et al. Late complication of Boari bladder flap. Eur Radiol. 2003;13(7):1604–7.

    Article  PubMed  Google Scholar 

  54. Wenske S, Olsson CA, Benson MC. Outcomes of distal ureteral reconstruction through reimplantation with psoas hitch, Boari flap, or ureteroneocystostomy for benign or malignant ureteral obstruction or injury. Urology. 2013;82(1):231–6.

    Article  PubMed  Google Scholar 

  55. Patil NN et al. Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation. Urology. 2008;72(1):47–50. discussion 50.

    Article  PubMed  Google Scholar 

  56. Fifer GL et al. Robotic ureteral reconstruction distal to the ureteropelvic junction: a large single institution clinical series with short term follow-up. J Endourol. 2014;28(12):1424–8.

    Article  PubMed  Google Scholar 

  57. Kozinn SI et al. Robotic versus open distal ureteral reconstruction and reimplantation for benign stricture disease. J Endourol. 2012;26(2):147–51.

    Article  PubMed  Google Scholar 

  58. Do M et al. Robot-assisted technique for Boari flap ureteral reimplantation: is robot assistance beneficial? J Endourol. 2014;28(6):679–85.

    Article  PubMed  Google Scholar 

  59. Musch M et al. Robot-assisted reconstructive surgery of the distal ureter: single institution experience in 16 patients. BJU Int. 2013;111(5):773–83.

    Article  PubMed  Google Scholar 

  60. Schimpf MO, Wagner JR. Robot-assisted laparoscopic distal ureteral surgery. JSLS. 2009;13(1):44–9.

    PubMed Central  PubMed  Google Scholar 

  61. Shah K et al. Surgical management of lower urinary mesh perforation after mid-urethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia. Int Urogynecol J. 2013;24(12):2111–7. Large series reporting on the outcomes of repair of lower urinary tract mesh perforation.

    Article  PubMed  Google Scholar 

  62. Sweat SD et al. Polypropylene mesh tape for stress urinary incontinence: complications of urethral erosion and outlet obstruction. J Urol. 2002;168(1):144–6.

    Article  PubMed  Google Scholar 

  63. Padmanabhan P et al. Approach to management of iatrogenic foreign bodies of the lower urinary tract following reconstructive pelvic surgery. J Urol. 2012;187(5):1685–90.

    Article  PubMed  Google Scholar 

  64. Hilton P. Urodynamic findings in patients with urogenital fistulae. Br J Urol. 1998;81(4):539–42.

    Article  CAS  PubMed  Google Scholar 

  65. Spradling K, et al. Redefining the autonomic nerve distribution of the urinary bladder using three-dimensional image reconstruction. J Urol. 2015. First comprehensive 3D model of the bladder autonomic innervation.

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S.F. Faris: none.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Sarah F. Faris.

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This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction

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Faris, S.F. Functional Outcomes of Bladder Reconstruction Secondary to Trauma and Ureteral Injury. Curr Bladder Dysfunct Rep 10, 436–442 (2015). https://doi.org/10.1007/s11884-015-0335-2

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