Prevention and Management Following Complications from Endourology Procedures

Endourologic procedures are very common in daily urologic practice for treatment of benign prostatic obstruction, stone disease, urothelial tumors, or stenosis.

To characterize the complications following endoscopic procedures, to describe their management, and to gather information about their prevention in current urologic practice.

A review of the literature was conducted using PubMed/Medline database to include the most relevant articles on the topic. The search focused on endoscopic approaches for treatment of prostate, bladder, or upper urinary tract disease. Percutaneous approaches and noninvasive extracorporeal techniques were excluded. Complications of endourologic procedures were identified through level 1 evidence, systematic reviews of the literature, or original articles assessing complications as the primary end point. Data about management and prevention of each type of complication were retrieved in a second round using specific keywords.

Complications of endoscopic urologic procedures are specific to each surgical approach. Main complications after prostate surgery include transurethral resection of the prostate syndrome, bleeding and transfusion, acute urinary retention, urinary tract infection, clot retention, postoperative irritative symptoms, ejaculatory dysfunction, urinary incontinence, bladder neck contracture, and urethral stricture. Major complications after transurethral bladder tumor include severe bleeding, transfusion, bladder perforation, and urinary tract infection. The most frequent complications after ureteroscopy are fever and sepsis, bleeding, steinstrasse, and ureteral injury. Overall, the literature is very poor, with no systematic reporting of complications and underuse of classification systems. No clear protocols are available for management of complications, and most are based on studies with low levels of evidence. Good clinical practice recommendations and guidelines give useful support about technical issues, intraoperative safety, and prevention of urinary tract infection. The efficacy of these preventive measures remains poorly investigated.

Complications following endoscopic surgery are potentially numerous and vary with patient characteristics, surgical approach, and type of medical device. Improved standardization and quality of publications are warranted to improve knowledge of these issues, which are directly linked to the level of care.

We focused on the potential complications of each endoscopic approach used to treat urologic disease. We described the frequency of these complications and gathered information about how to manage them in the operating theater. We also noted caveats for the literature regarding standardization of reporting and classification systems.

European urology focus. 2016 Apr 13 [Epub]

Jean Nicolas Cornu, Thomas Herrmann, Olivier Traxer, Brian Matlaga

Department of Urology, Rouen University Hospital and University of Rouen, Rouen, France. Electronic address: ., Department of Urology and Urological Oncology, Hanover Medical School, Hanover, Germany., Department of Urology, Tenon Hospital, Pierre and Marie Curie University, Paris, France., James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.