S10C98 - Complications of Urologic procedures and devices Flashcards
Uro-surgery complications: lithotripsy
- extracorporeal shock wave lithotripsy (high intensity sound waves)
- abdo/flank pain, n/v (48h post), skin ecchymosis, ureteral colic/fever, hematura (
Uro-surgery complications: vasectomies
- bleeding, scrotal hematoma, infxn, epididymitis, painful sperm granulomas
- mgmt: analgesia, consider Abx
- ice packs, scrotal support, analgesia
- if suspicious of abscess (diffuse pain, swelling, fever) get an u/s
- obtain uro consult for hematoma or abscess
Uro-surgery complications: adult circumcision
- -bleeding, infxn, pain, hematomas, swelling, suture tears, wound dehiscence
- consult uro, Abx, local wound care, hemostasis with direct pressure, thrombostatic agent, suture ligation for bleeding
Uro-surgery complications: prostate surgical procedures
- hematuria, blood clots, retention, urethral strictures, UTI, obstructive/irritative Sx, incontinence, dysuria, hesitancy, dribbling, urgency, frequency
- assess for hemodynamic instability, give IV fluids, do u/a, CBC, type/screen, renal fxn
- obstruction: 3 way foley, manual irrigation then CBI until clear or slight pink, monitor lytes to assess for hyponatremia
Uro-surgery complications: urinary catheters - infxn
- 1-2% risk of UTI if catheter 30d
- bacteria in short-term catheters: e coli, klebsiella, pseudomonas, enterobacter, staph
- long-term catheter bacteria: polymicrobial - e coli, proteus, pseudomonas, morganella, morganii, candida
- asymptomatic bacteriuria - remove foley, only treat if pregnant or pending uro procedure
- suprapubic catheters have lower infxn rate
- replace catheter if in for >7d
- catheter assoc UTI: abx for 5-14d, cefotaxime or CTX
- if polymicrobial or toxic pt: ampicillin plus gentamicin OR pip-taz OR meropenem OR fluoroquinolong depending on sensitivities
Uro-surgery complications: catheters - obstruction/leakage
- can become obstructed from concretions
- tx: bladder irrigations, methenamine tx, removal of catheter, abx
- balloon that doesn’t deflate: introduce guidewire into balloon inflation channel to dilate the channel and allow deflation, cystoscopy, uro consult, u/s guided percutaneous rupture of the ballon using a needle
- peri-urthral leakage occurs from bladder spasm or catheter obstruction, flush catheter, use antispasmodics such as oxybutynin
Uro-surgery complications: catheter traumatic complications
-prevention: lubrication, proper sizing
-trauam: tears, false lumens from trauma
-suspect bladder perforation if: peritoneal signs, pyuria, hematuria, decr u/o
obtain cystogram and urgent uro consult
Uro-surgery complications: percutaneous nephrostomy
- indications for nephrostomy: supravesical obstruction, adjunct to lithotripsy, ureteral stents or for urinary diversion if trauma or urteral transection, and percutaneous nephrolithotomy
- complications: bleeding, infxn, injury to lungs, liver, spleen, bowel
- check: Hb, reanl fxn, coag studies, type and xmatch, transfuse and resusc and give Abx as needed
- mechanical complications: catheter dislogement, tube blockage –> do CT
- refer to urology
Uro-surgery complications: artificial urinary sphincters
-used for incontinence, consists of pump, inflatable cuff, and pressure-regulating reservoir balloon
-complications: bleeding, infxn, malfunctions, hematomas
-abx
-some hematomas may need to be drained
-device may need to be removed if infected
-urethral erosion can occur w/in several months after surgery presenting with pain, swelling, incontinence, bloody d/c, infxn
requires cystourethroscopy
-recurrent incontinence, think: cuff erosion, infxn, fistula, mechanical failure
Uro-surgery complications: ureteral stents
-infxn: UTI, most managed with out/pt Abx and no stent-removal required
if pyelonephritis - give IV Abx, image to determine position of stent and consult uro (plain xr usually ok)
-sx: flank pain, bladder irritation, painful voiding
tx with analgesics and anticholinergics, u/a to exclude UTI
-new sx require investigating for migration, infxn, obstruction
-microscopic hematuria not usually clinically significant, gross hematuria can indicate erosion
Uro-surgery complications: ED devices
Intracarernosal Injxn:
papaerine, phentolamine, alprostadil, prostaglandin E
pain, priapism (erection >6h), hematoma
-if priapism present, uro consult, terbutaline or alpha adrenergic agonist injection (pehylephedrine) and corporal aspiration of lbood
Intraurethral injection:
- alprostadil, or MUSE (pellet inserted into urethra)
- drug percolates through urthera into corpora
- few SE: pain, bleeding, laceration of cavernosal artery, priapism
Vacuum device and penile splints:
- uses negative pressure to cause venous and arterial congestion
- pain during application or ejaculation, local skin cyanosis, skin necrosis, bleeding, ischemia, ecchymosis, peyronie dz and fourneir gangrene
- splints have few side effects
Penile Prostheses
- surgical implantation devices
- post-op complications: urinary retention, hematoma, infection
- infxn: staphylococcus epidermidis, staph aureus, gm - bacilli
- sx: pain along device, erosion, purulent urethral d/c
- abx and implant removal
Urinary diversion and Orthotopic bladder substitution
- ileal conduit and stoma
- postop complications: bowel obstruction, pyelonephritis, skin breakdown, stenosis of stoma, inflammation of upper tract d/t reflux
- bacteruria is common
- infxn dx: fever, flank pain, change in symptoms, culture and at least 10 to the 4th power colony-forming units/mL
Complications of male genital-related Foreign bodies
- piercings, constricting devices, urethral FB
- piercings can cause parphimosis or urethral injury, hematoma, urethral rupture
- infxn: cellulitis, sepsis, TSS, endocarditis –> staph aureus
- cock rings: ulceration, necrosis, gangrene, remove the device, assess for temp/color/sensation/ability to void/presence of pulses (doppler)
- consult uro for ischemia, urethral injury, inability to remove object from penis
- urethral FB: dysuria, hematuria, UTI, urinary retention, pain, swelling
- get an XR, give Abx, get uro consult
