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INTRODUCTION: From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. METHODS: The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. "Overlooked" urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11-36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6-1.5%). RESULTS: Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. DISCUSSION/CONCLUSION: Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.
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Complicações Intraoperatórias/etiologia , Sistema Urinário/lesões , Humanos , Doença IatrogênicaRESUMO
INTRODUCTION: Urinary system iatrogenic injuries appear because of urological, obstetric-gynecological, and surgical manipulations in the retroperitoneal space, pelvis, or perineum. The purpose of this research was to analyze and obtain knowledge about the issue of iatrogenic injuries, to apply injury prevention algorithms, and to assess multidisciplinary perspectives in modern surgery. MATERIAL AND METHODS: The research was interdisciplinary and consisted of several modules: a prospective, 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 numerous 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 of initial treatment policy, and more satisfactory treatment in patients' opinion. The research allowed for the identification of a typical procedural mistake in the urethral catheter setting causing a high risk of urethra injuries followed by urethra strictures or consecutive infections of the urinary tract. CONCLUSIONS: More complicated treatment procedures cause a higher probability of urinary system iatrogenic injuries. The absence of unified algorithms and typical procedural mistakes cause such incidents. A partial solution to this issue could be found in a more profound interdisciplinary interaction in all treatment phases as well as in identifying and eliminating procedural mistakes.
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Corrective lower limb osteotomies are innovative and efficient therapeutic procedures for restoring axial alignment and managing unicompartmental knee osteoarthritis. This review presents critical insights into the up-dated clinical knowledge on osteotomies for complex posttraumatic or congenital lower limb deformities with a focus on high tibial osteotomies, including a comprehensive overview of basic principles of osteotomy planning, biomechanical considerations of different implants for osteotomies and insights in specific bone deformity correction techniques. Emphasis is placed on complex cases of lower limb osteotomies associated with ligament and multiaxial instability including pediatric cases, computer-assisted navigation, external fixation for long bone deformity correction and return to sport after such osteotomies. Altogether, these advances in the experimental and clinical knowledge of complex lower limb osteotomies allow generating improved, adapted therapeutic regimens to treat congenital and acquired lower limb deformities.