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Complications of urologic procedures and devices

Complications of urologic procedures and devices. 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.

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Complications of urologic procedures and devices

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  1. Complications of urologic procedures and devices

  2. 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.

  4. 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.

  6. 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.

  7. 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)

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

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