Complications of urologic procedures and devices

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Complications of urologic procedures and devices
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• Extracorporeal shock wave lithotripsy-high
  intensity sound waves to break up calculi.
• Patients may present to the ED complaining of
  abd/flank pain, n/v, skin ecchymosis, ureteral
  colic, hematuria and fever.
• More serious complication include perinephric and
  renal hematomas. Present with severe flank pain
  and evidence of bleeding.
• Treat with fluids, blood, analgesics, and
  antibiotics. Consult Urology.

3

• Post ESWL stone fragments can accululate in the
  ureter. May necessitate repeat ESWL.
• Other abd. Organs have been damaged in during
  ESWL (bowel perf., GI mucosal erosions,
  hemorrhages, ureteric perf, splenic trauma.

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• Vasectomies are generally safe but post op
  bleeding and scrotal hematomas and infections are
  a possibility.
• Pain management and antibiotics when indicated
  should be used. If abscess is suspected, U/S
  should be used and Urology consult obtained.

5

• Common complications from prostate surgery
  include hematuria, blood clots, and retention,
  urethral strictures and UTIs.
• Triple lumen catheter should be placed for
  hemorrhage to remove clots.

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• Catheters can cause infection, obstruction,
  leakage and traumatic complications that occur
  during catheter placement.
• Adequate lubrication and proper size selection
  help reduce risk of trauma. During insertion, a
  false lumen can be created causing trauma.
• A Coude catheter or large sized catheter should
  be used with less force if problems with
  insertion occur.
• Bladder perforation is a rare but possible
  occurance.

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• Percutaneous nephrostomy is used for supravesical
  or ureteral obstruction or adjunctive therapy
  with ESWL and ureteral stents.
• Complication risk is low but includes bleeding,
  infection, obstruction, puncture of organs
  (lungs, liver, spleen, arteries)

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• Artificial urinary sphincter is used for urinary
  incontinence secondary to sphincter disturbance,
  post surgical incontinence, neurogenic bladder,
  uretheral trauma.
• Postoperative complications of the AUS device
  include bleeding, infection, and mechanical
  malfunctions.

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• Mechanical malfunctions include air bubbles,
  leaks, and tube kinking.
• Urethral erosion can also occur 3-4 months after
  surgery.
• DO NOT attempt to place a urinary catheter
  through the AUS.

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• Ureteral stents are used to relieve ureteral
  obstruction and maintain ureteral patency.
• Complications include-fever, infection,
  irritative bladder symptoms and hematuria.
• Most infections can be managed outpatient, but if
  systemic infection is suspected IV antibiotics,
  imaging, and urology consult is needed.

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• In long term stent placement, migration and
  fragmentation can be seen leading to obstruction
  and infections.
• Some pts with Erectile Dysfunction have devices
  or precedures performed such as vacuum therapy,
  penile injections, penile splints, and penile
  prosthesis placed.

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• Vacuum pumps can cause skin necrosis, urethral
  bleeding, ischemia, hemorrhage.
• Penile injections are available intracavernosal
  and intraurethral. These injections can cause
  penile pain, prolonged erections, priapism and
  hematoma. Priapism must be treated emergently
  with trebutaline, alpha-adrenergic agonists, and
  corporal aspiration of blood.

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• Implantable penile prostheses are used including
  rigid rod prosthesis, semirigid device, and
  inflatable devices. Infections can occur with
  all of these due to foreign body reaction.
• Migration and erosion through the tip of the
  penis warrant removal. Penile ischemia and
  necrosis are rare but can occur.

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• Body piercing of the genitals is becoming more
  common. In evaluating cases of complications,
  who placed the piercing and where, composition of
  piercing, comorbid conditions, postprocedural
  care.
• Infections and trauma are common complications.
• Paraphimosis, urethral injury, contact
  dermatitis, embedded and migrating jewelry are
  common problems.

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• Penile strangulation due to encircling ring can
  lead to edema, ulceration, necrosis, and gangrene
  of the penis.
• Prompt removal is a must. Check for penile temp.,
  color, sensation, ability to void, presence of
  pulse (Doppler) and urethral integrity. Consult
  Urology.