Perioperative serum creatinine changes and ureteral injury
| Autor: | Philip J. Chan, Junchan Joshua Yune, Joo Kim, Jeffrey S. Hardesty, Sam Siddighi, Nicole B. Kwon |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Nephrology medicine.medical_specialty Urology Computed tomography urologic and male genital diseases Urogynecology 03 medical and health sciences chemistry.chemical_compound Gynecologic Surgical Procedures 0302 clinical medicine Ureter Internal medicine Ureteral injury medicine Humans Perioperative Period Aged Retrospective Studies Creatinine 030219 obstetrics & reproductive medicine medicine.diagnostic_test urogenital system business.industry Cystoscopy Perioperative Middle Aged female genital diseases and pregnancy complications Surgery medicine.anatomical_structure ROC Curve chemistry Area Under Curve Case-Control Studies 030220 oncology & carcinogenesis Urologic Surgical Procedures Wounds and Injuries business Ureteral Obstruction |
| Zdroj: | International Urology and Nephrology. 49:1915-1919 |
| ISSN: | 1573-2584 0301-1623 |
| DOI: | 10.1007/s11255-017-1674-z |
| Popis: | To illustrate a simple method that screens for ureteral injury in the acute postoperative period after urogynecologic surgeries. 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. 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. 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. |
| Databáze: | OpenAIRE |
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