Evaluation of complications in urooncologic surgeries and recommended criterias

Purpose: Variations of clinical practice, rising costs regarding to constrained resources in most health care systems in recent years increased interest to evaluate the quality of surgery. Therefore, composing the approved criterias for reporting of surgical morbidity and outcomes is important in order to increase quality of patient care and determining the efficacy of surgical techniques.New Findings: Undetermimined standarts of surgical complications hamper evaulatiing the surgical performance and quality. Reporting of surgical complications is important for determiming the grade of recommendations of new techniques in guidelines. However, randomized control trilas with high level of evidance is sparse in surgical literature and this limitation leads to be low grade of recommendations. In the literature, Five standardized system proposed for reporting and classification of surgical complications. The Clavien- Dindo system is widely used especially in general surgery and urology. However, this system is not appropriately used in one third of urological publications. There are several situations that affect the accurate and comprehensive reporting of the complications such as the discrepancy of opinions of different professions about complications, inconsistency of the severity of the complications reported by the physicians and the patients, the absence of the observer dependent reliability. Although the literature have shown that the quality of the studies in the field of urooncology were inadequate to evaluate the surgical techniques and outcomes, there is a slight progress in minimal invasive radical prostatectomy literature in recent years.Conclusion: We consider that the European Association of Urology Guidelines Panel recommendations about reporting and grading complications in urologic surgery could contribute to maintain the standards which are currently inadequate

ureter injury during posterior lumbar disc surgery

Major vascular injuries during lumbar disc surgery are rare but well-recognized complications. However, vascular injuries of the branches of the aorta and ureteral injuries are very rare. Although its incidence is not known definitely, it is estimated to be 1/1000. Ureteral injuries comprise less than 1% of all genitourinary traumas. In this article, we report clinical progress of a patient who had simultaneous internal iliac artery and ureteral injury during lumbar discectomy. The patient was managed with primary ureteroureterostomy. To our knowledge, this is the first case reported with simultaneous ureter and iliac artery trauma during lumbar disc surgery

Posterior nutcracker syndrome: caused by pelvic pain

Posterior nutcracker syndrome is one of the abdominal venous entrapments caused by compression of the left renal vein between the vertebral column and the abdominal aorta. In this article, we report our first experience in a patient with posterior nutcracker syndrome who was referred to our clinic with pelvic congestion symptoms. A 39-year-old female patient was admitted to our clinic with the complaint of pelvic pain especially on the left side. Abdominal computed tomography angiography demonstrated vascular congestion appearance extending from pelvis at retroperitoneal space On the left side. End-to-side gonadocaval bypass was performed to the patient. Postoperative abdominopelvic tomography revealed that perirenal and retroperitoneal hematoma resolved completely. All of her previous complaints disappeared in the second postoperative months. We believe that gonadocaval bypass is an open surgical procedure which can be safely performed for selected patients