Urologic complications of major pelvic surgery

Abstract

The close proximity of pelvic organs makes the genitourinary system susceptible to injury during major pelvic surgery. Iatrogenic injury remains the most common cause of lower urinary tract trauma. Recent modifications in surgical technique, such as sharp mesorectal incision and nerve‐sparing radical prostatectomy, have decreased the incidence of many of these complications. Genitourinary complications due to pelvic surgery remain common, however, and as new surgical advancements are made, new complications may present. An understanding of the prevention, recognition, and treatment of urologic complications is important for every surgeon performing major pelvic surgery. Semin. Surg. Oncol. 18:216–228, 2000. © 2000 Wiley‐Liss, Inc.

Management of Complications of Prostate Cancer Treatment

“…Care should be taken not to hyperextend the shoulders or hips, as this may cause brachial plexus or lumbar plexus injuries. 14,15 The eyes should also be protected by the anesthesia team since corneal abrasions and conjunctivitis from corneal irritation by saliva have been reported in some series. 14 …”

Chapter 1

“…Although the correlation between ED and depression is well documented, the causal relation between both is sometimes inaccurate and most likely bidirectional, that is, ED can either accompany depression or depression can result from such sexual dysfunction. Other risk factors include trauma, 20 irradiation 21 or pelvic region surgery, 22 use of drugs, 23 chronic renal failure 24 and benign prostatic hyperplasia, [5][6][7][8]13,15,17,25 in addition to further medical …”

Perioperative Complications in Colorectal Surgery

“…13,14 When recognized at the time of injury, and properly repaired, bladder injury seldom leads to significant postoperative morbidity, but if it is not diagnosed or if it is mismanaged, it may cause pelvic abscess, hydronephrosis, urinary ascites, or more commonly, fistula formation. 15 The repair of a bladder injury is not difficult if it is identified during surgery. Because the bladder has an excellent blood supply, it heals easily.…”

“…A two-layer repair is generally recommended, and the suture line should be checked for a leak by distending the bladder with saline. 15 If the injury is on the posterior aspect, an associated ureteral injury should be ruled out. In the absence of extensive injury, radiation cystitis, or severe bleeding, a 20F to 24F urethral catheter alone can provide urinary diversion.…”

“…If the patient is severely ill or prolonged catheter drainage is anticipated, a large suprapubic catheter can be used for more adequate and effective drainage. 15 If no complications occur, the catheter can be removed after 5 to 7 days.…”