Abstract: Aim: was to evaluate the feasibility and effectiveness of using transperineal access for sanitation of «deep» exudative pelvic lesions in patients after gynecological operations. Materials and methods: results of percutaneous drainage with perineal access of «deep» – perirectal postoperative exudative pelvic lesions in 18 patients after extirpation of the uterus in oncological pathology were subjected to retrospective analysis. Exudative formations in the pelvis were detected during continuous postoperative ultrasound screening of operated patients starting from 3rd day of the postoperative period, taking into account clinical data. Perineal access was used in patients with verification of the nature of the pathological contents and subsequent drainage of the pathological exudation zone by 8fr drains with form memory using Seldinger method. Results: manipulation was successful in all 18 patients. In 5 cases, a lyzed pelvic hematoma was drained, and in 13 cases, an abscess was drained. In three cases, the connection of the abscess cavity with the lumen of the rectum was revealed. There were no complications due to manipulation. The drainage period was 6-7 days for hematoma and 10-16 days for abscess without internal fistula. If there is a connection with the lumen of the rectum, the drainage period was 21 days, the drainage was removed with x-ray confirmed closure of the internal fistula. Conclusion: our first positive experience of using transperineal access for the rehabilitation of intrapelvic exudative complications of the postoperative period in oncogynecological patients inspires cautious optimism, expands the arsenal of mini-invasive methods of treatment of intra-pelvic postoperative exudative complications, but undoubtedly requires further research for optimal integration of the technique into the practice of oncogynecology and x-ray surgery departments. References 1. Lorenz JM, Al-Refaie WB, Cash BD, et al. ACR appropriateness criteria radiologic management of infected fluid collections. J Am Coll Radiol 2015; 12: 791–799. 2. Hynes D, Aghajafari P, Janne d'Othee B. Role of Interventional Radiology in the Management of Infection. Semin Ultrasound CT MR. 2020 Feb; 41(1):20-32. 3. Kadrev AV. Punctures under the control of echography in the diagnosis and treatment of pelvic fluid in women. Cand. of med. sci. diss. Мoscow. 2007: 159 [In Russ]. 4. Albuquerque A, Pereira E. Current applications of transperineal ultrasound in gastroenterology. World J Radiol. 2016; 8(4): 370-377. 5. Sperling DC, Needleman L, Eschelman DJ, Hovsepian DM, Lev-Toaff AS. Deep pelvic abscesses: transperineal US-guided drainage. Radiology. 1998; 208(1):111-5. 6. Golferi R, Cappelli A. Computed tomography-guided percutaneous abscess drainage in coloproctology: review of the literature. Tech Coloproctol. 2007; 11: 197–208. 7. Khurrum Baig M, Hua Zhao R, Batista O, et al. Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol. 2002; 6: 159–164. 8. De Kok BM, Marinelli A.W.K.S., Puylaert J.B.C.M., et. al. Image-guided posterior transperineal drainage for presacral abscess: An analysis of 21 patients. Diagn Interv Imaging. 2019; 100(2): 77-83.
Abstract: Aim: was to assess the possibility of x-ray surgical recovering of the integrity of the upper urinary tract in the absence of dilatation of kidney collecting system. Material and methods: for the period of 2018-2020, under our supervision there were 9 patients with an unexpanded kidney collecting system against the background of the existing external or internal urinary fistula. In 6 patients after cystoprostatectomy and ureteroenterocutaneostomy (Bricker surgery), a migration of urethral drainage occurred. In 3 cases, after gynecological operations, patients were diagnosed with iatrogenic complete transverse ureter damage with the formation of retroperitoneal (intrapelvic) uroma. At the first stage in all 9 patients we performed percutaneous nephrostomy on unexpanded kidneys’ collecting system under ultrasound guidance using special techniques. To restore patency of the damaged ureter, a combined ante-retrograde approach was used. The antegrade flexible guidewire was moved through damaged (cut off) ureter, and retrograde through the entrance of damaged ureter or enterostomy with a capturing device, under x-ray control, the guidewire was brought out. Then, pyeloureteral drainage was placed in an adequate position of the enterocutaneostomy retrograde or antegrade, splinting the ureter damage zone. Results: in 6 patients, after Bricker surgery, the lost ureteral drainage was adequately restored. In patients with a cut off ureter, it was possible to restore the course of the damaged ureter on the external-internal pyelo-urethral drainage by closing the internal urinary fistula and eliminating retroperitoneal urine by percutaneous drainage under radiation control. There were no complications associated with the technique of x-ray surgery. Conclusion: percutaneous nephrostomy on an unexpanded kidney collecting system using special techniques for the verification of kidney collecting system is a potentially replicable safe technique that allows to perform in stages adequate external derivation of urine. Percutaneous nephrostomy can be used as a «bridge» technique for subsequent x-ray surgical interventions on the ureter, including with its complete iatrogenic damage.
References 1. Patel U, Hussain FF. Percutaneous nephrostomy of non-dilated renal collecting systems with fluoroscopic guidance: technique and results. Radiology. 2004 Oct; 233(1 ):226-233. https://doi.org/10.1148/radiol. 2331031342 2. Liu BX, Huang GL, Xie XH et al. Contrast-enhanced US-assisted Percutaneous Nephrostomy: A Technique to Increase Success Rate for Patients with Nondilated Renal Collecting System. Radiology. 2017 Oct; 285(1):293-301. https://doi.org/10.1148/radiol.2017161604 3. Usawachintachit M, Tzou DT, Mongan J et al. Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System. J Endourol. 2017 Feb; 31 (2): 129-134. https://doi.org/10.1089/end.2016.0693 4. Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol. 2011 Dec; 28(4):424-37. https://doi.org/10.1055/S-0031-1296085 5. Brandes S, Coburn M, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: an evidencebased analysis. BJU Int. 2004 Aug; 94(3):277-89. https://doi.org/10.1111 /j.1464-410X.2004.04978.X 6. Ray CE Jr, Brown AC, Smith MT, Rochon PJ. Percutaneous access of nondilated renal collecting systems. Semin Intervent Radiol. 2014 Mar; 31 (1):98-100. https://doi.org/10.1055/S-0033-1363849 7. American College of Radiology (ACR) and the Standarts of Practice Committee of the Society of Interventional Radiology (SIR) and the Society for Pediatric Radiology (SPR) practice guideline for the performance of percutaneous nephrostomy. Revised 2011 (resolution 42). Accessed March 9, 2013. http://www.arc.org/~/media/ACR/Documents/PGTS/guidelines/Percutaneous_Nephrostomv.pdf 8. Clark TW, Abraham RJ, Flemming BK. Is routine micropuncture access necessary for percutaneous nephrostomy? A randomized trial. Can Assoc Radiol J. 2002 Apr; 53(2):87-91.
