Bladder Bag

Bladder Bag
Hiking Bag, inside pocket of bladder?

The Internet is curently ompletely being useless, so I have to ask people real results. my Grandma just bought a bag of hiking, and has a label that says you have a pocket inside the bladder. What is this??

I think the bladder is used to store water … similar to CamelBak, which is a backpack that holds water, you can drink. I think the bladder has the same purpose for long walks.

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A review study of bladder injuries Inn laparoscopic assisted vaginal hysterectomy

Introduction
 
Bladder injury is very serious complication of lap assisted vaginal hysterectomy
Retrospective method of analysis

Type of procedure surgical laparoscopic assisted vaginal hysterectomy laparoscopic assisted vaginal hysterectomy out using three port sign symptom bladder injury during surgery balloon distension of the bag catheter in the bladder with co2 gas or liquid discharge clear in the field of operational management of hematuria bladder injury during surgery because of the primary bladder lesion and perforation secondary trocar. Hasson technique to open laparoscopy may reduce three types of injury 0.2 º and third trocar is inserted under vision after surgery increased the risk by warning cystostomy placement of the bladder in tension near the navel or because the surgery site on the road adhesion secondary trocar. Furthermore foregoing may result in the formation Obliterator adhesion to the position of the accession of the bladder can in the area of cervical-vaginal junction as a result of previous caesarean section and deploy the team the bladder was low in the uterus. other mechanical damage. blunt dissection scissors or accession or seen by the lady of the bladder may be the Accession surgery prior infection in relation to the intestine, appendix, peritonitis.

Thermal injury

Excessive bleeding may be responsible for thermal destruction of the bladder. use of unipolar cautry near the surface of the bladder should be avoided. Vesico vaginal fistula can occur after laparoscopic surgery. uterus that is extracted from the bladder using unipolar or bipolar coagulation cautry excessive thermal may be responsible for thermal necrosis of the bladder. Thermal necrosis there may be some only appear after the transplant, when a vesico-vaginal fistula occurs a fistula can also occur if the bladder is taken when the vagina is stitched below.

Diagnosis

Injection methylene blue through a urinary catheter will settle the diagnosis of vesico-vaginal fistula. IVP retrograde cystogram should also be made through Revaluation

Presentation of the bladder lesions

To minimize injury of the bladder in patients with vaginal involvement anterior lateral Tran cesarean should be used to enter the previous culture-de-sac during laparoscopic hysterectomy interfacial side window of the vesico vaginal space conscious first opened. Trauma care Veress needle trocar. Catheter can be managed with the madness for a week without further complications. Injury to the bladder during laparoscopic assisted vaginal hysterectomy is small and is loaded at some distance from the trigone of the bladder can be removed laparoscopically two layers of material Closer delayed absorbable suture and check that the bladder is sealed by the injection of 300 ml of methylene blue through the catheters.

Incident bladder injury 4-7 1000

Sign to acknowledge the bladder injury, even after intraopeartive

1. CO2 catheter bag during insufflation

2. The bladder appears to be driven by the accessory trocar as it moves through the abdomen and

3. Blood in urine

4. Urine drainage of the accessory trocar incision

5. Postoperative urinary retention

6. Postoperative peritonitis

7. Indigo carmine drain the lesion site

Injury Prevention Insert bladder secondary ports under direct vision.

1. Separate the bladder lower uterine segment by sharp dissection never bluntly dissect the bladder

2. Make sure that the bladder is not within the gain of laparoscopic stapling device before firing.

3. Avoid excessive electro around the bladder surgery

Treatment

1. Repair depends on whether the injury is thermal or mechanical

2. If the injury at the base of the dome of the bladder

3. The proximity of the injury to the trigone and ureteral opening

 

 

Treatment

If diagnosed at the time of surgery. Bladder dome can be repaired in a simple two-layer C PDS. Is the layer that contains it must be continuous muscular layers of the mucosa. Instillation of indigo carmine dye to facilitate identification of the limits of bladder repair laparoscopic vesico vaginal if you have after surgery is performed after about 12 weeks. vesico-vaginal space was developed as vaginal bladder were closed separately the bladder to the vagina with vicryl PDS. A flash peritoneal space was used to separate vesico vaginal and sutured with vicryl. approach Abdominal should use the following.

1. Inadequate exposure due to high or retracted fistula in a tight vagina.

2. The proximity of the ureter fistula

3. Multiple fistulas

4. bladder associated with pelvic pathology must be neutralized before surgery

New Technique

A new technique for dissecting the bladder laparoscopically was detected by the James Cook University Hospital during laparoscopically assisted vaginal hysterectomy in the surgery department at least access. We reviewed 130 LAVH was dissected by laparoscopic bladder a catheter wire was used identification to stretch the edge of the bladder and a sponge forceps virginal was inserted to mark the site for previous Colpotomy bladed scissors used to open virgin was a 0.7% bladder injury was immediately recognized and repaired knot laparoscopically body within the average running time was 198.7 minutes recorded the average hospital stay was 2.7 days with a range of 2-5 days, the dissection of the bladder laparoscopically adds 5-10 minutes to operating time, but significantly easier to identify appropriate plane is an easy technique to learn and teaching is associated with minimal complications with no increase in the incidence of injury or bladder dysfunction bladder injury with laparoscopy is rare, said et al reported 1.6% incidence of serious urinary complications after major operative? Laparoscopy is the most bladder perforation or fistula are four new cases of bladder injury in a series of 900 laparoscopic hysterectomy for three of the women had gone in 2 or 3 c sections woman goes under the vaginal hysterectomy is chances of bladder injury if they had previous c section. In this study of these reports 130 consecutive LAVH were dissected the bladder and ureteral vaginal pouch opened laparoscopically. This technique was initially designed for women who had previous c section in which the bladder is sticky and difficult to identify and analyze vaginal technique was later adopted in all cases, it appear ed to be more easily and safely vaginally then this technique was used 130 LAVH performed in hospital james cooking technique was used in all patients in the Old Testament same technique of high inlet pressure 25 mm Hg with 3 ports plus 10 mm umbilical port with 5 mm port inserted under direct vision in the right iliac fossa and left after epigastric vessels and inserts a pubically above. bipolar diathermy and scissors were used to secure pedicle down but not including both round ligaments uterine vessels were secured by bipolar diathermy peritoneum was dissected of a round ligament on the other side. A catheter was inserted after the metal in the bladder catheter was rotated so that the tip was pointing upwards to stretch the room bladder pillars of the bladder was dissected with monopolar scissors catheter in place. A sponge forceps was pushed then into the vagina to stretch the anterior fornix the vagina and mark the site of colpotomy monopolar scissors used to open the vagina and the use of cutting diathermy and shoot just before contact with the vaginal tissue helped coagulation to achieve hemostasis without significant vagina opened in layers until it arrived with sponge forceps have been pressed in the neighborhood and opened sheet widely used to stretch the colpotomy procedure was completed vaginally. A Wertheim retractor is placed through the bladder to protect the uterine arteries were first secured with clamps and fixed with vicryl followed by sacral cardinal ligament and uterus and intra peritoneal drain and urinary catheter until the next day resulted in a total 130 patients 12 had sections C Mean operative time was 98.7 minutes. There was a bladder injury that was recognized immediately and knotted laparoscopic repair intra corporeal. Cystoscopy is performed to ensure proper repair of the bladder and to exclude any other injuries. Patients have a bladder catheter for 7 days to 6 months Postoperative management was well with no residual bladder dysfunction.

Discussion

It is difficult to detect the incidence of injuries of the bladder with laparoscopic surgery in general, especially LAVH Gilmour et al (9) reported that major gynecological surgery the incident of bladder injury varied from 0.2 -19.5 / per thousand over all frequencies from 2.6 per thousand on the basis of medlinereach for all reports between 1996 and 1998. He found a higher incidence of bladder injury when routine cystoscopy with the range of 0 to 29.2 and especially the frequency of 10.4 per thousand. Author said that only 51.6% of the bladder lesion was identified and during the operation. Ostrzenski et al (10) reported the overall incidence of bladder injury during the laparoscopic procedure to the range of 0.022% to 8.3% of cases. These injuries occurred most often during LAVH. surgical dissection Sharp instruments had electro injury. Intra-operative diagnosis of bladder injury was present in 53.24% of all cases of bladder injuries dome of the bladder is most commonly injured structure. Less than half 29.87% of bladder injuries were corrected laparoscopically. In this series one bladder injury occurred when the catheter was forced to bladder wall perforation through this way. The injury was immediately identified and successfully repaired laparoscopically without permanent residual bladder dysfunction. Using metal catheter to stretch the bladder helps to identify the limit to the bladder and the pillars. What significantly facilitate the recognition of the dissection and release the bladder, especially in patients with extensive dissection healing should take place until one is confident that the bladder is completely freed from the vagina and the use of sponge forceps to stretch the vaginal wall clearly mark the site for colpotomy. Other studies large are needed for more accurate estimate of bladder trauma. Cystoscopy was not performed routinely unless the indigo was suspected bladder injury carmine is injected intravenously a few minutes before cystoscopy. Some authors recommend routine use of cystoscopy with hysterectomy because of the high incidence of the bladder Vakili undetected injuries to (11) recently reported an incident of 4.8% of urinary tract injury during hysterectomy and therefore conclude that the routine cystoscopy should be considered. Harkki-siren al (12) reported the complication rate of one thousand by laparoscopy but with a major complication rate of 10 per thousand with surgery laparoscopic 19% percent of major complications in these severe ureteral injuries was 46% were intestinal lesions. They found that 75% of the most important complication LAVH is associated with and commented that many of these may be due to the technique as the uterine vessels coagulated and cut by laparoscopy, 86% of the time and effort of ensuring that vessels diathermy or staples can result in much more ureteral injuries (13). In this series of ureteral injury not as laparoscopic dissection stopped on vessels of the uterus and the procedure was then completed vaginally. A recent systematic review and meta-analysis of randomized controlled trial to compare abdominal and vaginal LAVH was published by Johnson et al (14). They reported a significant increase of the lesion in the urinary tract and laparoscopic compared abdominal hysterectomy with odds ratio 2.6, 95% so there was no significant difference when comparing laparoscopic versus vaginal hysterectomy or laparoscopic versus LAVH. In this series opted for LAVH visco et al reported 2.6% of urinary tract damage occurred between 2998 LAVH total cases. Evaluate study published by Ginny et al (17) 2.1% reported bladder injuries in laparoscopic hysterectomy compared with 1% in the abdominal hysterectomy. Comparison of laparoscopic bladder injury vaginal hysterectomy and reported 0.9% and 1.2% respectively. The incidence of bladder lesions in Gasser series was 0.7% lower due to the ease of identifying and dissecting of the bladder.

Conclusion

If you are careful you can easily avoid injury to the bladder, following the above directors mentioned. This study describes Gasser bladder dissection laparoscopically adds 5-10 minutes running time. The use of metal catheter help identify the margin of the bladder and the stretching of the bladder pillar aircraft are easily recognized. The site forceps vaginal sponge clearly m arks the vagina and thus to colpotomy. Technique is easy to learn and adopt, especially in patients with paragraph c above. Incident bladder main advantage is low is to facilitate the dissection of the bladder when there is significant commitment. The technique is associated with low incidence of bladder injury.

Reference

1) Schutz K, M Possover, Merker A, Michels W, Schneider A (2002) A prospective randomized comparison of laparoscopic assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of uterus weighs 200g>. Surg Endosc 16: 121-125.

2) T Stovall, Elder R, Ling F (1989) Predictors of pelvic adhesions. Report Med J 34: 345-348.

3) A Zapico, P Fuentes, Grass, Arnans F, J Otazu, Cortes-Prieto J (2005) Hysterectomy laparoscopic assisted vaginal versus abdominal hysterectomy in stages I and II endometrial cancer: performance data, tracking and survival, Gynecol Oncol 98: 222-227.

4) Harkki-Siren P, Kurki T (1997) A nationwide analysis of laparoscopic complications. Hynecol Gynecology and Obstetrics 89: 108-112

5) Harkki-Siren P, Sjoberg J, Titina A (1998) Urinary tract injuries after hysterectomy, Obstet Gynecol 92: 113-118

6) Ostrzenski A, Ostrzenska KM (1998) Bladder injury during laparoscopic surgery in Gynecology and Obstetrics Gynecol Surv 53: 175-180

7) Rooney CM, Crawford AT, Vassallo BJ, Kleeman SD, Karram MM (2005) are previous cesarean section a risk for incidental cystotomy at the time of hysterectomy? A case-control study, Am J Obstet Gynecol 193:2041-2044

Armenakas NA, Pareek G, Fracchia JA (2004) Iatrogenic bladder perforations: long term follow-up of 65 patients. J Am Coll Surg 198: 78-82

9) Matheved P, Valencia P, Cousin C, Mellier G, Dargent D (2001) Operative injuries during vaginal hysterectomy, Europ J Obstet Gynecol Repord Biol 97: 1971-1975

10) Berek and Novak's Gynecology (2007) Lippincott Williams & Wilkins, Philadelphia, 14 pp, ed. 805-811

11) M Vessy, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D (1992). The epidemiology of hysterectomy: finding in a cohort study. Br J Gynaecol Obsted 99: 402-407

12) M Cosson, Lambaudie E, M Boukerrou, Querleu D, Crepin G (2001) Vaginal, laparoscopic, or abdominal hysterectomies for benign bisorders: postoperative complications immediate and early. Eur J Obstet Gynecol Reprod Biol 98: 231-236

13) Sheth SS, Malpani AN (1995) vaginal hysterectomy after cesarean. Int J Gynecol Obsted 50: 165-169

14) Hsu WC, Chang WC, Huang SC, Torng PL, Chang D, Sheu a. C. (2006) Visceral sliding technique is useful for detecting adhesion and prevent complications abdominal laparoscopic surgery. Gynecol Obstet Invest 62: 1975-1978

15) Chang WC, Huang SC, Sheu BC, Chen Cl, Torng PL, Hsu WC, Chang DY (2005) Transvaginal hysterectomy or laparoscopically assisted vaginal hysterectomy for cervical nonprolapsed. Obstet Gynecol 106: 321-326

16) Chang WC PL Torng, SC Hunag, Sheu BC, Hsu WC, Chen RJ, Chow SN, Chang DY (2005) laparoscopically assisted vaginal hysterectomy with ligation of the uterus through ligament artey retrograde umbilical monitoring. J Minimal Invasive Gynecol 12: 336-342

17) Aronson MP, Bose MT (2002) Preoperative bladder injury in pelvic surgery. Obsted Gynecol Clin 45: 428-438

18) G Neumann, Raswmussen KL, Lauszus FF (2004) Peroperative bladder injury during hysterectomy for benign disorders. Record Obstet Gynecol Scand 83: 1001-1002

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