Urinary System Iatrogenic Injuries: Problem Review

Abstract

<b><i>Introduction:</i></b> From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. <b><i>Methods:</i></b> The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. “Overlooked” urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11–36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6–1.5%). <b><i>Results:</i></b> Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. <b><i>Discussion/Conclusion:</i></b> Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.

Single-cell and spatial mapping Identify cell types and signaling Networks in the human ureter

“…However, congenital defects and injuries of this structure can lead to significant medical issues that severely compromise patients' quality of life. Ureteral stricture is a common sequela of iatrogenic injury from surgery or radiation but can also be caused by benign conditions, such as impacted ureteral calculus, retroperitoneal fibrosis, or abdominal aortic aneurysm (Gild et al, 2018;Vorobev et al, 2021). If left untreated, ureteral stricture can lead to pain, repeat infections, kidney stones, and permanent loss of renal function.…”

Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy

“…Common mechanisms of iatrogenic surgery are direct injury (crushing, squeezing, transection, suture ligation and coagulation) and indirect injury (devascularization, energy induced and generation of free oxygen radicals) [ 12 ]. Iatrogenic ureteral stricture is more likely to be induced in the lower third of ureter than the middle and upper third [ 13 , 14 ]. Nearly 70% of stricture located in the lower third ureter in our study, which is consistent with the previous report [ 13 , 14 ].…”

“…Iatrogenic ureteral stricture is more likely to be induced in the lower third of ureter than the middle and upper third [ 13 , 14 ]. Nearly 70% of stricture located in the lower third ureter in our study, which is consistent with the previous report [ 13 , 14 ].…”

Retardation of Bacterial Biofilm Formation by Coating Urinary Catheters with Metal Nanoparticle-Stabilized Polymers

“…In addition, zwitterionic polymers form a hydration layer that affects the adhesion of bacteria and their response [ 30 ]. Antimicrobial agents added to catheters, referred to as antifouling agents [ 21 ], can act via different mechanisms, such as the slow release of biocidal or bacteriostatic agents [ 31 ], modification of the inner surface of catheters to decrease bacterial adhesion [ 2 ], and contact killing [ 3 ]. One of the most effective techniques is to disrupt the formed biofilm inside the catheter, which has shown promising results in controlling urinary tract infections.…”