EAU Guidelines on Iatrogenic Trauma

Summerton, Duncan J.; Kitrey, Noam D.; Lumen, Nicolaas; Serafetinidis, Efraim; Djakovic, N.

doi:10.1016/j.eururo.2012.05.058

Cited by 186 publications

(269 citation statements)

References 81 publications

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“…Mismatch between the size of the instrument and the diameter of the urethral meatus results as meatal strictures, whereas bulbar strictures occur due to insufficient insulation by the lubricant. In order to prevent strictures, lubricant gel must be reapplied when the resection time is getting longer (13,14).…”

Section: Stricture After Transurethral Prostate Resectionmentioning

confidence: 99%

Urethral Stricture is an Unpleasant Complication after Prostate Surgery: A Critical Review of Current Literature

Söğütdelen¹,

Haberal²,

Guliyev³

et al. 2016

jus

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Prostatectomy is one of the main causes of surgery in aging male population. Besides traditional techniques, novel minimally invasive approaches may also end up with certain complications following prostate surgery. Transurethral procedures may cause iatrogenic urethral trauma. Factors that may influence the development of iatrogenic endoscopic urethral strictures include "electrical dispersion" generated by unipolar current and the "diameter of the instruments" used. Those complications not only bother quality of life of the patients but also may cause various adjunctive procedures with an economical impact.Urethral stricture is the abnormal narrowing of any segment of the urethra surrounded by corpus spongiosum. It specifically means varying degrees of spongiofibrosis that refers to scarring of the corpus spongiosum (1). Any inflammation of the urethra can result in scarring that can lead to a stricture or a narrowing of the urethra. Besides prostate surgery, trauma, infections, tumors or any other cause of scarring may trigger urethral stricture (2). A recent metaanalysis including 732 patients showed that idiopathic and iatrogenic etiologies were by far the most common, accounting for 33% and 33% of all cases, respectively. Inflammatory and posttraumatic etiologies were found in only 15% and 19% of patients, respectively (3).Here, we tried to review the incidence and the basic risk factors that cause urethral stricture following prostate surgery. ÖZÜretral striktür enflamasyona bağlı olarak skarlaşma sonrası üretradaki daralmadır. Elli yaş üzeri erkeklerde benign ve malign hastalıklara bağlı olarak yapılan prostatektomiler oldukça yaygın olarak uygulanmaktadır. Prostatın transüretral rezeksiyonu sonrası farklı serilerde %19'a kadar çıkan oranlarda üretral darlık ve mesane boynu kontraksiyonu görülmektedir. Lazer prostatektomi sonrası üretral darlık prostatın transüretral rezeksiyonuna oranla daha az olarak görülmektedir, yaklaşık olarak %3,6 oranındadır. Açık prostatektomi en eski yöntem olmasına rağmen büyük prostat boyutlu hastalarda oldukça mantıklı bir alternatiftir. Açık prostatektomi sonrası yaklaşık olarak %1,9-4,8 oranında darlık bildirilmiştir. Radikal prostatektomi (RP) lokalize prostat kanseri tedavisinde bütün dünyada en yaygın olarak uygulanan yöntemdir. RP sonrası anastomoz seviyesinde mesane boynu kontraksiyonu olması iyi bilinen bir komplikasyondur ve yaklaşık olarak hastaların %0,4-32'sinde görülmektedir. Darlık büyük oranda endoskopik yöntemlerle tedavi edilmektedir, nadiren komplike olgularda bukkal mukoza greftli üretroplasti gerekebilmektedir. Anahtar Kelimeler: Üretral darlık, prostat cerrahisi, transüretral rezeksiyon, açık prostatektomi, radikal prostatektomi ABSTRACTUrethral stricture is narrowing of the urethra due to inflammation that results in scarring. Prostatectomies for benign and malign prostatic diseases are common surgical procedures among men mainly after their fifties. Urethral stricture or bladder neck contraction following transurethral resection of the prostate (TURP)...

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Section: Stricture After Transurethral Prostate Resectionmentioning

confidence: 99%

Urethral Stricture is an Unpleasant Complication after Prostate Surgery: A Critical Review of Current Literature

Söğütdelen¹,

Haberal²,

Guliyev³

et al. 2016

jus

View full text Add to dashboard Cite

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“…However, bladder perforation caused by transurethral resection rarely requires surgical treatment. Risk factors for bladder perforation during transurethral resection include tumor size, age, prior bladder treatments (such as previous TURB, intravesical instillation, or radiotherapy), and location of the tumor (dome or diverticulum) [5]. In the present case, the size of the tumor was fairly large (3.8 cm), and the patient was elderly (80 years) and had undergone three prior TURB surgeries.…”

Section: Discussionmentioning

confidence: 75%

“…After surgery, it is discovered through CT, cystoscopy, or cystogram [5,15]. Early discovery is critical, as postoperative discovery of bladder rupture increases the risk of TURS or peritonitis due to the prolonged accumulation of irrigation fluid within the abdominal cavity.…”

Section: Discussionmentioning

confidence: 99%

“…Transurethral resection is the most efficacious and safest treatment for superficial tumors, but it is associated with various complications, including hemorrhage, urinary tract obstruction, and infection. In rare cases, it also leads to serious complications, such as bladder perforation and subsequent irrigation fluid leakage into the abdominal cavity, TURS, and sepsis [5,8].…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative ventilation and hemodynamic change due to bladder perforation during transurethral resection of a bladder tumor - A case report -

et al. 2017

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Transurethral resection is a common, effective urologic procedure performed to resolve urinary tract obstruction in benign prostatic hypertrophy, prostate cancer, and bladder cancer. However, its complications include hemorrhage, infection, transurethral resection syndrome (TURS), bladder perforation, urinary tract obstruction, urinary incontinence, and sepsis [1,2]. While bladder perforation occurs in up to 58% of all cases, cases of bladder perforation that require surgical treatment are rare [3,4]. Risk for bladder perforation CASE REPoRTAn 80-year-old male patient (weight 50 kg, height 158 cm) was scheduled to undergo transurethral resection of the bladder (TURB) for multiple masses, including a 3.8-cm mass in the left bladder wall, and prostatic hypertrophy. He had a history of hypertension with no other notable disease history, and had undergone three previous transurethral resection surgeries. Preoperative chest X-ray, pulmonary function test, electrocardiography, and echocardiography findings were normal. Two days before the operation, his hemoglobin and hematocrit counts were reduced to 8. Transurethral resection is the most efficacious and safest urologic procedure for the treatment of benign prostatic hypertrophy, prostate cancer, and bladder cancer. Complications of transurethral resection include hemorrhage, infection, transurethral resection syndrome, and bladder perforation. Early detection of bladder perforation is important because it can cause critical ventilation and hemodynamic changes. In this case, we detected bladder perforation as the cause of ventilation and hemodynamic change intraoperatively and treated it by immediate surgical repair.

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“…If intraperitoneal perforation is recognized, the current standard is to proceed with an open laparotomy to rule out bowel injury and to close the bladder perforation. 6 However, this invasive approach may lead to other complications and increased length of hospitalization. These additional risks merit exploration of less invasive options.…”

Section: Introductionmentioning

confidence: 99%

A minimally invasive approach to transperitoneal perforation of the bladder during bladder tumour resection

Bishay

Honey

2016

CUAJ

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The authors present a case of intraperitoneal rupture of the bladder during transurethral resection of a bladder tumour (TURBT), which was managed conservatively. By passing a urethroscope -which was smaller in diameter than the perforation -through the hole, a small superficial burn was identified on the adjacent bowel and deemed benign, saving this patient with multiple comorbidities from having to undergo an open laparotomy. The bladder was drained with a Foley catheter to allow the perforation to heal and the patient was discharged without incident. By using this approach, a direct view of the neighbouring structures confirmed the integrity of bowel and prevented the need for increased risks associated with a laparotomy.

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EAU Guidelines on Iatrogenic Trauma

Cited by 186 publications

References 81 publications

Urethral Stricture is an Unpleasant Complication after Prostate Surgery: A Critical Review of Current Literature

Urethral Stricture is an Unpleasant Complication after Prostate Surgery: A Critical Review of Current Literature

Intraoperative ventilation and hemodynamic change due to bladder perforation during transurethral resection of a bladder tumor - A case report -

A minimally invasive approach to transperitoneal perforation of the bladder during bladder tumour resection

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