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

Bladder: Can We Predict the Patients Who Will be Resistant to Treatment?

Aims: The main objective of this study was to define urinary biomarkers that can predict the severity of overactive bladder and detect patients who would benefit most from treatment. Methods: Patients with an OAB diagnosis and healthy controls were included in the study. A bladder diary and a validated OAB questionnaire were given to all patients. In the OAB group, solifenacin 5mg daily was given for 1 month. Urine samples were taken before the treatment and after the first month of the treatment in both groups and urinary BDNF, NGF, GAG, and MCP-1 levels were measured. Results: A total of 45 OAB patients and 45 healthy age-matched controls were included. BDNF/Cre, NGF/Cre, MCP-1/Cre, and GAG/Cre levels were significantly higher in the OAB group. The levels of these biomarkers significantly decreased after 1 month of solifenacin treatment. After treatment, 66.7% of patients OAB symptoms were relieved and 33.3% did not respond to the treatment. Although basal biomarker levels did not differ between responder and non-responder groups, the ratio of decrease in biomarker levels was significantly higher in treatment-sensitive patients. Postmenopausal women were more resistant to treatment when compared with the premenopausal group. Conclusions: Urinary biomarkers have a role in the pathophysiology of OAB however they did not predict the patients who would benefit from the treatment and in whom antimuscarinics would be useless. Future studies with higher numbers of patients and different OAB subgroups are needed to investigate the exact role of these ( and other) biomarkers. (C) 2015 Wiley Periodicals, Inc