medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 05

<< Back Next >>

Ginecol Obstet Mex 2020; 88 (05)

Cistorraphy dehiscence in patients with uterine arteries embolization due to placentary acretism: report of two cases

Espinosa-García CM, Rodríguez-Colorado SE, Ramírez-Isarraraz C, Gorbea-Chávez V, Granados-Martínez V, Cruz O, Rodríguez-Bosch M

Language: Spanish
References: 13
Page: 334-341
PDF size: 294.96 Kb.


ABSTRACT

Background: The incidence of percretism is 5-7% with 78% of complications associated with surgical management. There are few reported cases of cystorraphy dehiscence after uterine arteries embolization.
Clinical cases: Case 1. A 34 years old patient with a pregnancy of 36 5/7 weeks and acretism; she was treated with uterine artery embolization plus subtotal hysterectomy with bladder injury repaired without complications. She was discharged, and in 2 weeks she consulted for vaginal urine loss and fever (acute pyelonephritis); cystorraphy dehiscence was diagnosed with support of tomography and retrograde cystography. Bilateral ureteral catheterization, laparotomy with trachelectomy plus resection of bladder necrotic edges and cystorraphy were performed. Case 2. A 30 years old patient with a pregnancy of 37 5/7 weeks and acretism; equal treatment of acretism was given with bladder injury repaired without complications. She was hospitalized útein surveillance for obstetric haemorrhage and urinary infection with torpid evolution; she referred vaginal urine loss at 2 weeks, so cystoscopy, tomography and retrograde cystography were performed which diagnosed cystorraphy dehiscence. In surgery the bladder defect was located by cystoscopy and hysteroscopy and bilateral ureters were catheterized; subsequently, by laparoscopic approach necrotic bladder edges were resected and cystorraphy was performed. Both patients without complications and with successful postoperative evolution.
Conclusion: Cystorraphy dehiscence in embolized patients is extremely rare; however, it should be considered as a possible complication. Diagnostic suspicion and timely management with resection of necrosis and new cystorraphy, achieve greater success.


REFERENCES

  1. Özcan HÇ, et al. Use of bladder filling to prevent urinary system complications in the management of placenta percreta: a randomized prospective study. Geburtshilfe Frauenheilkd. 2018;78(2):173-178. DOI: 10.1055/s-0044-100039

  2. Nieto-Calvache AJ, et al. Urinary tract injuries during treatment of patients with morbidly adherent placenta. J Matern Fetal Neonatal Med. 2019:1-7. DOI: 10.1080/14767058.2019.1678135

  3. Matsuzaki S, et al. Conservative management of placenta percreta. Int J Gynaecol Obstet. 2018; 140 (3): 299-306. doi: 10.1002/ijgo.12411

  4. Giurazza F, et al. Predelivery uterine arteries embolization in patients affected by placental implant anomalies. Radiol Med. 2018; 123 (1): 71-78. doi: 10.1007/s11547- 017-0796-9

  5. Poujade O, et al. Uterine necrosis following pelvic arterial embolization for post-partum hemorrhage: review of the literature. Eur J Obstet Gynecol Reprod Biol. 2013; 170 (2): 309-14. doi: 10.1016/j.ejogrb.2013.07.016

  6. Marín-Sánchez P, et al. Conservative management of vesicovaginal fistula after uterine and partial bladder necrosis due o embolization as a treatment for postpartum hemorrhage. Int Urogynecol J. 2015; 26 (5): 773-4. DOI: 10.1007/s00192-014-2617-1

  7. Hoffman MS, et al. Morbidity associated with nonemergent hysterectomy for placenta accreta. Am J Obstet Gynecol 2010; 202 (6): 628.e1-5. DOI: 10.1016/j. ajog.2010.03.021

  8. Mamik MM, et al. Risk factors for lower urinary tract injury at the time of hysterectomy for benign reasons. Int Urogynecol J 2014; 25 (8): 1031-6. doi: 10.1007/s00192- 013-2308-3

  9. Alanwar A, et al. Urinary tract injuries during cesarean section in patients with morbid placental adherence: retrospective cohort study. J Matern Fetal Neonatal Med 2019; 32 (9): 1461-1467. doi: 10.1080/14767058.2017.1408069

  10. Wu WJ, et al. Bladder necrosis associated with placenta accreta, embolization, and repair of cystotomies. J Endourol Case Rep 2015; 1 (1): 24-6. doi: 10.1089/cren.2015.29007. wjw

  11. Washington S, et al. Acute bladder necrosis after pelvic arterial embolization for pelvic trauma: lessons learned from two cases of immediate postembolization bladder necrosis. Case Rep Urol. 2016; 2016: 7594192. doi: 10.1155/2016/7594192

  12. Tayade S, et al. Vesicocervical fistula: a rare complication of lower segment caesarean section. Int J Biomed Res. 2012; 3 (4): 221-3. doi: 10.7439/ijbr.v3i4.395

  13. El-Azab AS, et al. Update on vesicovaginal fistula: A systematic review. Arab J Urol. 2019; 17 (1): 61-68. doi: 10.1080/2090598X.2019.1590033




2020     |     www.medigraphic.com