Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% (n = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, n = 11) and sepsis (2.4%, n = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.
Introduction The highest risk of intraoperative ureteral trauma is associated with hysterectomy, performed most frequently in postmenopausal women. The overall incidence of ureteral injuries varies in different studies between 0.5% and 10%. Case report Ureterovaginal fistula following laparoscopic subtotal hysterectomy with bilateral salpingoophorectomy is reported in this case. Ureteral injury was not noticed during operation. Two weeks after the operation the patient noticed constant urine leakage from the vagina. Discussion A computed tomography scan revealed dilation of the left renal pelvis and the upper two thirds of the ureter due to an inflammatory fibrous mass with air bubbles involving its lower part. Contrast medium outflow identified the site of urine leakage. Subsequently, diagnostic cystoscopy and ureteroscopy revealed a fistula between the ureter and the apex of the vagina. The patient developed an iatrogenic ureterovaginal fistula, which was repaired successfully with a ureteroneocystostomy over a double-J stent a month and a half later. At the follow-up 3 months post operation there was no urine leakage from the vagina, no hydronephrosis in ultrasound check-up or ureterovaginal fistula on vaginal examination. Conclusions This paper highlights the problem of unnoticed ureteral injury during gynaecological surgeries, which, if overlooked, can develop into severe complications. Causes of ureteral injuries, prevention, and possible treatment options are also discussed.
The COVID-19 pandemic had a tremendous impact on healthcare systems around the world. This study aims to research the course of surgical treatment in urology during the pandemic in 2020, evaluate the volume of deferred treatment in urology in Poland, and indicate groups of patients that are especially vulnerable to a delay in the delivery of healthcare services. The National Health Found statistics (NHF) database was searched for information on procedures completed in urology departments from 2015 to 2020. Changes in hospital discharges of adults from 2019 to 2021 were investigated using monthly reports of NHF on patient billing groups. Statistics of PSA, testosterone, and creatinine testing were extracted from NHF reports. Annual changes in the number of surgeries were calculated. Then, the estimation of the expected quantity of procedures without the occurrence of the pandemic was performed using linear regression based on data from 2015 to 2020. The estimation was assumed reliable at R2 > 0.8. The difference between collected and estimated data was analysed. In 2020, the volume of radical prostatectomies, cystectomies, and kidney surgeries noted downturns following lockdowns in March and November. All analysed procedures, except radical cystectomy, noted a reduction in the entire year. The declines reached −34% in shockwave lithotripsy, −13% in ureterorenoscopic lithotripsy, −22% in cystolithotripsy, −28% in percutaneous lithotripsy, −12% in transurethral resection of a bladder tumour (TURBT), −31% in transurethral resection of the prostate, −15% in nephrectomy and kidney tumorectomy, and −10% in radical prostatectomy. Among the analysed procedures, only radical cystectomy rates increased 5%. Prostate-specific antigen and creatinine tests fell −17%, and testosterone testing was down −18%. In conclusion, the patients most vulnerable to delayed treatment due to the post-pandemic backlog are those requiring TURBT, kidney cancer operations, and radical prostatectomies. Solving backlogs in urology should prioritise cancer patients and thus requires improved access to cystoscopy, TURBT, diagnoses and surgery of prostate and kidney tumours. Addressing the needs of patients suffering from benign diseases demands appropriate measures to increase the surgical productivity of urology departments.
Introduction Radical cystectomy (RC), beyond its therapeutic effect, is associated with significant rates of complications, hospital readmissions and mortality. In recent years much research has been made in order to clarify the main reasons of these events. This article, based on a literature review, presents the impact of risk factors on RC complications and highlights possible modifications of these factors to reach better RC outcome. Material and methods PubMed, Science Direct, Google Scholar databases were searched using key-words to identify studies about risk factors and RC complications between 2010 and 2021. A total of 96 articles were retrieved and studied as full-text versions. The most significant data was targeted, analysed and categorized according to the article’s design. Results All the most valuable risk factors of RC complications were grouped in patient-related, treatment-related risk factors and subgrouped in nonmodifiable, modifiable and potentially modifiable categories. All the modifiable and potentially modifiable risk factors were found to have considerable value, as their adjustment lowers the rates of morbidity and mortality. Conclusions Proper identification and adjustment of the risk factors present the possibility of better RC results. Although, in advanced disease and highly morbid cases, complications are not fully omit-table. Management of bladder cancer (BC) in high-volume centres using new technologies offers lower rates of complications. To sum up, rigorous interdisciplinary presurgical patient preparation should be implemented in BC management.
This report presents the case of a rare and aggressive cancer originating from the urachus in a 73-year-old female. After 12 years of observation due to a cystic lesion in the bladder dome, the patient rapidly developed haematuria and mucinuria. The use of multiple diagnostic measures suggested urachal malignancy. Partial cystectomy and urachal excision along with pelvic lymphadenectomy were performed. Urachal adenocarcinoma with negative surgical margins and lymph nodes was reported in pathology. Follow-up after 12 months did not reveal any cancer relapse. Epidemiological, clinical and therapeutic features of this disease are also discussed.
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