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Perioperative serum creatinine changes and ureteral injury

  • Urology - Original Paper
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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.

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Acknowledgements

The authors would like to thank Dr. Malcolm Hardy, Gynecology and Obstetrics resident, Loma Linda School of Medicine, and Mr. Shagy ElHalawany, MBA, for their assistance in editing and database analysis.

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Authors and Affiliations

  1. Female Pelvic Medicine and Reconstructive Surgery, Loma Linda University School of Medicine, 11234 Anderson St., Coleman Suite 11105, Loma Linda, CA, 92345, USA

    Sam Siddighi, Nicole B. Kwon & Jeffrey S. Hardesty

  2. Urology Department, Loma Linda University School of Medicine, 11234 Anderson St., Coleman Suite 11105, Loma Linda, CA, 92354, USA

    Junchan J. Yune

  3. Loma Linda University School of Medicine, 11234 Anderson St., Loma Linda, CA, 92354, USA

    Joo H. Kim

  4. Gynecology and Obstetrics Department, Loma Linda University School of Medicine, 11370 Anderson St., Suite 3950, Loma Linda, CA, 92354, USA

    Philip J. Chan

  5. 11350 Anderson St., Suite 3900, Loma Linda, CA, USA

    Sam Siddighi

Authors
  1. Sam Siddighi
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  2. Junchan J. Yune
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  3. Nicole B. Kwon
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  4. Jeffrey S. Hardesty
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  5. Joo H. Kim
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  6. Philip J. Chan
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Corresponding author

Correspondence to Sam Siddighi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Siddighi, S., Yune, J.J., Kwon, N.B. et al. Perioperative serum creatinine changes and ureteral injury. Int Urol Nephrol 49, 1915–1919 (2017). https://doi.org/10.1007/s11255-017-1674-z

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  • DOI: https://doi.org/10.1007/s11255-017-1674-z

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