Major Complications of Urologic Surgery

Abstract

Urological surgery encompasses open, laparoscopic, retroperitoneoscopic, and endoscopic procedures that concern andrology, oncology, urinary stones, pelvic organ prolapse, incontinence, and lower urinary tract symptoms. Grade III to V events, according to Clavien–Dindo classification, occur mainly in endoscopic, laparoscopic, retroperitoneoscopic, and open transabdominal surgery. The most dangerous surgical complications are acute bleeding, anastomosis leakage, urinary or intestinal fistulas, sepsis, excessive fluid absorption, and acute obstructive renal injury. Sometimes they may have a subtle insurgence, especially after endoscopic procedures, leading to late recognition with eventual catastrophic consequences. Prevention of major complications requires meticulous preoperative planning, whereas acknowledgement of symptoms or signs linked to complications is the key to an early diagnosis, which is imperative to limit ominous outcomes. The surgeon should be aware of preoperative conditions such as urinary infection, particularly if associated with the presence of a device (for example, urethral or ureteral catheters), previous complications from surgeries of the same kind, or certain medical disorders or therapies and the case should be discussed in a multidisciplinary setting if vascular, intestinal, or non-surgical complications are expected. After the procedure, patients should be monitored for uncommon events like hemodynamic instability, acute persisting pain, persisting postoperative ileus, postoperative onset of subcutaneous emphysema of the scrotum or the wound or the presence of gas in the collection bag of the drainage or the urinary stoma, high fever or severe malaise, impaired urinary output, abnormal color composition and characteristics of urine or fluid from drainage. Additional diagnostic tools may be necessary to confirm a suspected complication. Thereafter, prompt and tailored measures should be taken.