[P-168]

Conservative treatment of intraperitoneal urinary system injury during endoscopic urologic surgery

Department of Urology, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey

INTRODUCTION: Intraperitoneal perforation is a rare but serious complication. The traditional management has been a laparotomy but some researchers suggest percutaneous drainage of the abdomen at an early postoperative period. We present our patients and describe our experience with conservative treatment.

PATIENTS AND METHODS: First case was transurethral resection of the bladder tumor, second was direct vision internal urethrotomy, third ureterorenoscopy for treatment of ureteral stone ureterorenoscopy for treatment of ureteral stone, and fourth transurethral resection of prostate. All four patients were diagnosed perforation of urinary system with intraperitoneal fluid after endoscopic urologic surgery. Patients underwent percutaneous drainage of the abdomen. A Peritofix® (B Braun Melsungen AG, Melsungen, Germany) was inserted after infiltration of abdominal wall with 2% prilocaine for drainage of intraperitoneal fluid. (Figure 1) Ultrasound was used to protect abdominal organs from injury. All patients made a good recovery without any complications. None of our patients had laparotomy after percutaneous drainage.

DISCUSSION: Intraperitoneal perforation may cause peritonitis, sepsis and death. The traditional management has been a laparotomy with drainage of intraperitoneal fluid, repair of the injury, exclusion of bowel injury and placement of drainage catheters. In the absence of other intra-abdominal injuries, laparoscopic suturing of the intraperitoneal rupture is possible. Percutaneous drainage and antibiotic prophylaxis seems to be as effective as laparotomy in uncomplicated intraperitoneal perforation without peritonitis and ileus. The risk, which is rare, would be when there has been a concomitant injury to the bowel. If bowel injury were suspected, we suggest that laparotomy would certainly be the treatment choice. The advantages of the percutaneous drainage are that it avoids further anesthesia and it avoids the morbidity of laparotomy.

CONCLUSION: Although laparotomy remains the standart operation for intraperitoneal perforations, percutaneous placement of Peritofix® can be an alternative treatment. Patients must be monitored closely and if they continue to show signs of peritonism despite of catheter or if there is suspicion of bowel injury a laparotomy is recommended. We present small series of patients, so larger series with long term follow-up are needed for recommending percutaneous drainage as a safe method.

---

Resim 1: Peritofix katateri

Figure 1: Peritofix catheter