Lets just say, urology is not considered a glamorous specialty of medicine, such as plastic surgery or neurosurgery, for reasons I don’t need elaborate upon-) However, if you are a medical negligence lawyer, urology issues and complications will appear, especially if assisting clients in gynaecological matters. You will receive clinical notes possibly from a gynaecologist, a urogynaecologist or a urologist, which will refer to terms and procedures you may not be familiar enough with to understand the clinical notes. The following provides some helpful information to assist in gynaecological/urological matters.
Urinary tract injuries are a known complication of obstetric and gynecological surgeries because of their anatomical proximity. Delayed diagnosis and improper management leads to high morbidity and even mortality. Bladder injury is the most common urological injury during obstetric and gynaecology surgery, followed by ureteral injury, which is not typically recognized immediately and has the potential to be life-threatening or to result in permanent kidney damage or removal of a kidney.
Gynaecological surgery (open and laparoscopic) accounts for more than 50 percent of all ureteral injuries resulting from an operation, with the remaining occurring during colorectal, general, vascular and urologic surgery. Firstly, an understanding of the basic anatomy of the major urological organs is a great starting point:
The kidneys are embedded in a cushion of adipose (storage of fat) tissue and surrounded by fibrous connective tissue for protection. They are fist sized and weigh about 250 grams each.
The kidneys consist of an outer cortex (outer portion) and an inner medulla (inner portion).
Two Ureters (the usual number – may be more) are muscular tubes lined with mucous membrane. They convey urine in peristaltic (involuntary constriction and relaxation of the muscles creating a wave like motion) from the kidneys to the urinary bladder.
This is a hollow, muscular sac in the pelvic cavity and serves as a temporary reservoir for urine.
A tube through which urine is discharged from the urinary bladder by expulsion. The process of expelling (voiding) urine through the urethra is called micturition.
Ureteric Complications:The most reliable way for surgeons to avoid ureteral injury is to clearly identify the ureter throughout the region of the body that will undergo the operation. Sounds simple, however, the gynaecologist I was employed with for 8 years used to write in his surgical notes, “ureters identified” to ensure this important task was not only performed but noted, as many surgeons routinely don’t identify or note in their surgical notes. Most injuries occur in the segment of ureter closest to the bladder. The common types of pelvic ureteral injuries caused by surgery – in descending order of frequency – are ligation (tying), kinking by suture, division, partial laceration, crush and loss of blood supply (leading to delayed death of tissue and narrowing of the ureter).
Unfortunately, most ureteric injuries after gynaecological surgery are discovered in a delayed fashion. Injuries that are detected after an operation tend to be more complex, require more complex repairs and multiple procedures, and have more complications than those detected and repaired during the operation.
When diagnosis is delayed, sickness including body-wide response to serious infection, loss of kidney function and possible death can occur in up to 50 percent of patients. Rates for surgical removal of the kidney resulting from delayed diagnosis, overall, are seven times as common as when the ureter injury is diagnosed promptly (during surgery)
Bladder Complications: In gynaecological surgery, bladder injury most commonly occurs during abdominal hysterectomy. The bladder can be injured at four specific sites. If a bladder injury is noted at surgery, it usually can be easily managed by a two- or three-layer closure with absorbable suture and a catheter bladder drainage. Retrograde (reverse direction than normal) bladder filling with blue-colored saline makes bladder injury diagnosis easier. Typical delayed bladder complications are various forms of fistulas.
An expert opinion from a urologist, urogynaecologist or gynaecologist would be required in relation to the issue of negligence in the event of such circumstances. However, the above tips will provide you with a start in understanding urological complications in gynaecological surgery.
Urology issues may not be fascinating, however, its definitely an area that will present itself for your consideration, at some time during your medical negligence career.
The experience I gained from 15 years employment in medicine prior to law, in specialities, including gynaecology/obstetrics, nephrology, urology, plastic and reconstructive surgery, neurosurgery, neurology & ophthalmology have provided me with “industry insights” and knowledge.
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