Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.
Vagina/surgery ; Urologic Surgical Procedures/adverse effects ; Urinary Incontinence, Stress/*surgery ; Urinary Bladder/*injuries/radiography ; *Postoperative Complications ; Peritonitis/diagnosis/etiology ; Humans ; Female ; Cystoscopy ; Adult

Ketamine is a short-acting anaesthetic agent that has gained popularity as a 'club drug' due to its hallucinogenic effects. Substance abuse should be considered in young adult patients who present with severe debilitating symptoms such as lower urinary tract symptoms, even though the use of controlled substances is rare in Singapore. Although the natural history of disease varies from person to person, a relationship between symptom severity and frequency/dosage of abuse has been established. It is important to be aware of this condition and have a high degree of clinical suspicion to enable early diagnosis and immediate initiation of multidisciplinary and holistic treatment. A delayed diagnosis can lead to irreversible pathological changes and increased morbidity among ketamine abusers.
Adult ; Cystitis ; drug therapy ; Cystoscopy ; Female ; Fluoroscopy ; Humans ; Ketamine ; adverse effects ; Lower Urinary Tract Symptoms ; chemically induced ; Male ; Singapore ; Substance-Related Disorders ; complications ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Tract ; drug effects ; physiopathology ; Young Adult

PURPOSE: We undertook this study to evaluate the incidence, risk factors, management, and outcome of postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux (VUR). MATERIALS AND METHODS: Ninety patients undergoing endoscopic treatment for VUR were retrospectively reviewed and classified into two groups according to ureteral obstruction: the nonobstruction group (83 cases, 122 ureters; mean age, 7.0+/-2.8 years) and the obstruction group (7 cases, 10 ureters; mean age, 6.2+/-8.1 years). We analyzed the following factors: age, sex, injection material, laterality, voiding dysfunction, constipation, renal scarring, preoperative and postoperative ultrasound findings, endoscopic findings, injection number, and injection volume. Additionally, we reviewed the clinical manifestations, natural course, management, and outcome of ureteral obstruction after endoscopic treatment. RESULTS: The incidence of ureteral obstruction after endoscopic treatment was 7.6% (10/132 ureters). The type of bulking agent used and injection volume tended to be associated with ureteral obstruction. However, no significant risk factors for obstruction were identified between the two groups. Three patients showed no symptoms or signs after the onset of ureteral obstruction. Most of the patients with ureteral obstruction experienced spontaneous resolution within 1 month with conservative therapy. Two patients required temporary ureteral stents to release the ureteral obstruction. CONCLUSIONS: In our experience, the incidence of ureteral obstruction was slightly higher than in previous reports. Our study identified no predictive risk factors for developing ureteral obstruction after endoscopic treatment. Although most of the ureteral obstructions resolved spontaneously within 1 month, some cases required drainage to relieve symptoms or to prevent renal function deterioration.
Adolescent ; Child ; Child, Preschool ; Cystoscopy/*adverse effects ; Drainage ; Female ; Humans ; Hydronephrosis/etiology ; Male ; Postoperative Period ; Prognosis ; Remission, Spontaneous ; Retrospective Studies ; Risk Factors ; Stents ; Ureteral Obstruction/*etiology/pathology/therapy ; Vesico-Ureteral Reflux/*surgery