Urinary System Iatrogenic Injuries: Problem Review.

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.

A multidisciplinary approach to urinary system iatrogenic injuries.

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.

Complicated Issues of Medical Examination: A Case Study of the Irkutsk Region.

BACKGROUND: Medical examination of the adult population is aimed at diagnosing chronic noncommunicable diseases and their risk factors. The unreasonable choice of screening methods and information processing can lead to the unjustified waste of resources, with little benefit or even damage to the health of population and to the distortion of the statistic information. OBJECTIVES: To evaluate the quality of medical examinations for chronic noncommunicable diseases among the adult population of the Irkutsk region from 2013 to 2017. METHODS: We analyzed the Adult Clinical Examination report N 131 using comparative and statistical methods. It was selected for this study because it provides a summary of the findings from the Chronic Non-Communicable Diseases surveys from 2013 to 2017 and thus precluded unnecessary investment of time and labor. The report comprises sections 1000 to 7000, which provided medical examination data, such as demographic information and statistics on various diseases, including neoplasms. RESULTS: The years 2016 and 2017 were notable for the emergence of 567 new cancers, which accounted for 12.9% of total diagnoses. In 2017, there were 115 192 patients with cardiovascular diseases, a fivefold increase from 2013. Among the neurological dysfunctions, 0.9% were ischemia attacks and related syndromes. The remaining 99.1% were not highlighted in the report. The respiratory system diseases were pneumonia, bronchitis, chronic obstructive pulmonary disease (COPD), asthma, asthmatic status, and bronchiectasis. These diseases made up 68.3% of all pathologies of the respiratory system. The remaining 11 327 cases were not classified nosologically. CONCLUSION: Every section of the N 131 report showed significant inconsistencies among the summary survey results for both the Irkutsk Region and Russia. This could result in a misunderstanding of disease prevalence and, consequently, in improper decision making. At this point, approaches to statistical analysis of health surveys must be reconsidered on a national scale.