TY - JOUR
T1 - Prevention and Management Following Complications from Endourology Procedures
AU - Cornu, Jean Nicolas
AU - Herrmann, Thomas
AU - Traxer, Olivier
AU - Matlaga, Brian
N1 - Funding Information:
Complications following endoscopic surgery are potentially numerous and vary with patient characteristics, surgical approach, medical device, and surgeon experience. The actual rate remains difficult to estimate because of the lack of standardization and the low quality of currently available reports. Each type of complication can be at least partly prevented by following the rules for good clinical practice. Given the impact on patient care and the importance of assessment of new technologies, improved reporting and better standardized management of complications with the endoscopic approach would be highly beneficial. Author contributions: Jean Nicolas Cornu had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: CORNU, MATLAGA. Acquisition of data: CORNU, HERMANN. Analysis and interpretation of data: CORNU, HERMANN, TRAXER, MATLAGA. Drafting of the manuscript: CORNU. Critical revision of the manuscript for important intellectual content: CORNU. Statistical analysis: CORNU. Obtaining funding: None. Administrative, technical, or material support: None. Supervision: MATLAGA, TRAXER. Financial disclosures: Jean Nicolas Cornu certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Jean-Nicolas Cornu has received honoraria/travel grants/consultancies from Astellas, Pfizer, Coloplast, AMS, Mundipharma, Bard, GSK, BK Medical, Allergan, and EDAP-TMS. Thomas R. W. Herrmann is affiliated with Karl Storz GmBH (honoraria, financial support for attending symposia, financial support for educational programs, consultancy, advisory, royalties), Boston Scientific AG (honoraria, financial support for attending symposia, financial support for educational programs, consultancy, advisory board), LISA Laser OHG AG (honoraria, financial support for attending symposia, financial support for educational programs), and Ipsen Pharma (honoraria, financial support for attending symposia, advisory board). Olivier Traxer is a consultant for Coloplast, Boston Scientific, Rocamed, Olympus, and EMS. Brian Matlaga is a consultant for Boston Scientific. Funding/Support and role of the sponsor: None.
Publisher Copyright:
© 2016 European Association of Urology
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Context Endourologic procedures are very common in daily urologic practice for treatment of benign prostatic obstruction, stone disease, urothelial tumors, or stenosis. Objective To characterize the complications following endoscopic procedures, to describe their management, and to gather information about their prevention in current urologic practice. Evidence acquisition 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. Evidence synthesis 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. Conclusions 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. Patient summary 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.
AB - Context Endourologic procedures are very common in daily urologic practice for treatment of benign prostatic obstruction, stone disease, urothelial tumors, or stenosis. Objective To characterize the complications following endoscopic procedures, to describe their management, and to gather information about their prevention in current urologic practice. Evidence acquisition 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. Evidence synthesis 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. Conclusions 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. Patient summary 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.
KW - Bladder resection
KW - Complications
KW - Endoscopy
KW - Prostate
KW - Ureteroscopy
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U2 - 10.1016/j.euf.2016.03.014
DO - 10.1016/j.euf.2016.03.014
M3 - Review article
C2 - 28723449
AN - SCOPUS:84991619901
SN - 2405-4569
VL - 2
SP - 49
EP - 59
JO - European Urology Focus
JF - European Urology Focus
IS - 1
ER -