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A Multidisciplinary Approach to Urinary System Iatrogenic Injuries

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A Multidisciplinary Approach to Urinary System Iatrogenic Injuries 534 Central European Journal of Urology O R I G I N A L P A P E R TRAUMA AND RECONSTRUCTIVE UROLOGY A multidisciplinary approach to urinary system iatrogenic injuries Vladimir Beloborodov1, Vladimir Vorobev1, Igor Golub1, Aleksandr Frolov1, Elena Kelchevskaya1, Darizhab Tsoktoev1, Tatyana Maksikova2 1Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation 2Department of Propedeutics of Internal Diseases, Irkutsk State Medical University, Irkutsk, Russian Federation Citation: Beloborodov V, Vorobev V, Golub I, et al. A multidisciplinary approach to urinary system iatrogenic injuries. Cent European J Urol. 2020; 73: 534-543. Article history Introduction Urinary system iatrogenic injuries appear because of urological, obstetric-gynecological, Submitted: June 3, 2020 and surgical manipulations in the retroperitoneal space, pelvis, or perineum. The purpose of this research Accepted: Nov. 24, 2020 was to analyze and obtain knowledge about the issue of iatrogenic injuries, to apply injury prevention Published online: Dec. 14, 2020 algorithms, and to assess multidisciplinary perspectives in modern surgery. Material and methods The research was interdisciplinary and consisted of several modules: a prospec- tive, single-centre study of urinary system iatrogenic injuries (476 patients) along with four interregional and international procedural types of research. Results The analysis results indicate an extremely high significance of urinary system injuries evoking nu- merous negative consequences that are hard to eliminate. A comparative assessment of interdisciplinary interaction demonstrates the more effective interpretation of examination results, more comprehensive and credible clinical diagnosis, more qualitative evaluation of a patient’s condition, more effective choice Corresponding author of initial treatment policy, and more satisfactory treatment in patients’ opinion. The research allowed Vladimir Vorobev for the identification of a typical procedural mistake in the urethral catheter setting causing a high risk 1 Krasnogo Vosstaniya of urethra injuries followed by urethra strictures or consecutive infections of the urinary tract. Street Conclusions More complicated treatment procedures cause a higher probability of urinary system iatro- 664003 Irkutsk, Russian Federation genic injuries. The absence of unified algorithms and typical procedural mistakes cause such incidents. phone: +7 950 054 3210 A partial solution to this issue could be found in a more profound interdisciplinary interaction in all treat- [email protected] ment phases as well as in identifying and eliminating procedural mistakes. Key Words: kidney iatrogenic injury ‹› ureter iatrogenic injury ‹› urethra iatrogenic injury ‹› urinary bladder iatrogenic injury ‹› urinary system iatrogenic injury INTRODUCTION implies a broad discussion of medical cases or joint treatment, including surgical manipulations. It is Urinary system iatrogenic injuries include ureter, not new for urologists to interact with oncologists, urinary bladder, urinary tract, and kidneys injuries. radiologists, gynecologists, proctologists, and other It is widely thought that the main reasons for such specialists [4, 5]. In some cases, multidisciplinarity injuries are urological, obstetric-gynecologic, and reflects a lack of general knowledge when interact- surgical manipulations involving the retroperitoneal ing specialties in isolation do not study the stated space, pelvis, or perineum [1, 2]. issue (urogynecology, pelvic surgery) [6]. Analysis of literature data on urinary system iat- In the era of rapid progress, approaches to multidis- rogenic injuries allows for the making of some con- ciplinary medical help are changing [7]. A modern clusions. Firstly, the issue is properly studied and clinician is hardly able to make a complicated math- analyzed [2, 3]. A classic multidisciplinary approach ematical and statistical analysis of research results Cent European J Urol. 2020; 73: 534-543 doi: 10.5173/ceju.2020.0153 535 Central European Journal of Urology on his or her own – it is more efficient to use the ser- ria was carried out prospectively by the continuous vice of statisticians, special software, and/or artificial sampling method. intelligence [7, 8]. During the research, 615 patients had iatrogenic One of the outstanding branches of interdisciplin- injuries of the urinary system. The research inclu- ary science is tissue-engineered surgery [9], when sion criteria fit 476 patients. All included patients a team of interacting biologists, urologists, chemists, received conservative or surgical treatment. morphologists, biotechnologists work for a collective Out of 476 patients initially included in the research, goal. 247 were subsequently excluded: 211 patients Modern multi-layer spiral computed tomography dropped out due to deviations from the study proto- (MSCT) equipment allows doctors to get highly de- col, and 36 due to personal reasons. tailed 3D models of internal organs and pathological The inclusion criteria were: processes. Nowadays it is hard to imagine planning – Confirmed acute iatrogenic injury of one of these a kidney resection concerning the malignant tumor organs (kidney, ureter, bladder, urethra); without a 3D model showing vessels, the kidney col- – The patient had complications after the previous lecting system, and surrounding organs [10, 11]. injury to one of these organs (kidney, ureter, blad- Making a high-quality model requires concerted ef- der, urethra); forts from a urologist, radiologist, IT specialist, and – The patient is over 18 years old; the use of special software. A model can be printed – The patient signed a voluntary informed agree- with a 3D printing station and used for rehearsing ment to participate in the study. operation steps and team interaction [11, 12]. A more The exclusion criteria were: extensive, though the not less important, applica- – Absence of convincing data for the iatrogenic na- tion of 3D printing is caused by making consumables ture of the injury; (stents, catheters, etc.) considering an individual pa- – The patient did not sign a voluntary informed tient’s anatomic features [13, 14]. agreement to participate in the study; The basis of multidisciplinary interaction is an edu- – The patient refused to participate at any stage cational program which should consist of modules of the research; delivered by different departments helping a student – Due to any reason, the patient did not complete during one semester get mutually supportive infor- the planned examination and treatment. mation letting to make an overall pattern of a normal The research has the following endpoints: or pathological process, a disease function, and prog- – The primary ‘solid’ endpoint is the examination ress, and to develop true critical thinking [6, 8, 15]. not earlier than three months after treatment The current review of urinary tract iatrogenic inju- and detected relapse at any stage of the postop- ries and multidisciplinary interaction issues has re- erative observation. sulted in setting the following goal: to analyze and – The secondary ‘soft’ endpoints are signs of a com- gain knowledge about the current condition of the plication as a result of iatrogenic injury and com- issue of iatrogenic injuries, to apply preventive mea- plication relapse after treatment. sures algorithms and to assess multidisciplinarity The research incorporated anamnestic, clinical, bio- perspectives in modern surgery. chemical, radiological, ultrasound, magnetic reso- nance, and endoscopic methods. An anamnestic MATERIAL AND METHODS method allows for establishing the possible cause and duration of the disease. The research was comprehensive and consists of sev- Laboratory tests included clinical analysis of blood eral modules. and urine, determination of total protein, blood A prospective, single-centre study of urinary system sugar, creatinine, urea, bilirubin, amylase and trans- iatrogenic injuries (partially presented) was per- aminase activity, and water-electrolyte balance formed in the urological hospital Irkutsk city clini- in the blood. All patients underwent bacteriologi- cal hospital Nº1. The clinical part of the research cal urine test, electrocardiography, and ultrasound includes an analysis of the examination and treat- of the urinary tract with an assessment of the re- ment results of patients who underwent therapeutic sidual urine volume. Patients estimated the quality measures for urinary system injuries and their com- of life (QoL) by using the self-test standard question- plications from September 2016 to November 2019. naires. Patients recorded complaints, satisfaction The research includes male and female patients, with the state of health, and prescribed treatment. over 18 years old, with an established diagnosis To clarify the nature and degree of pathological of urinary system iatrogenic injuries. The selection changes, examination included uroflowmetry, ure- of patients for the study who fit the inclusion crite- throcystography, urethrocystoscopy, ureterorenos- 536 Central European Journal of Urology copy, MSCT, or magnetic resonance imaging (MRI) Federation participated in the examination study of the urinary system with or without contrast (due on knowledge of the urinary system's topographic to any contraindications) with 3D image reconstruc- anatomy and signs of injuries. From October to No- tion for the final verification of the diagnosis. vember 2019, doctors of various specialties
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