The Inert and the Living in Urologic Surgery
Seance of wednesday 14 june 2017 (LA JONCTION INERTE / VIVANT EN CHIRURGIE)
DOI number : 10.2699/3ws8-7b28/emem.2017.3.013
Abstract
Urology is a medical surgical specialty, which rarely uses synthetic prostheses. Two situations have to be distinguished: drainage and/or instillation devices, which are in contact with urine, and occlusive or compression devices, which are located outside urinary flow.
The first case is mainly represented by urethral or ureteral prostheses. Those devices are sources of early infections and stone obstructions. For instance, 80% of nosocomial urinary tract infections are related to the presence of a bladder catheter, which represents a major public health issue in terms of morbidity, resistance to antibiotics and financial cost.
The second case is mainly represented by devices used to cure urinary incontinence and pelvic floor disorders: urethral and promontofixation slings, periurethral balloons, artificial urinary sphincter. Those devices have a high rate of success, with low morbidity and excellent tolerance, as far as they have no contact with urine. Nevertheless, in case of urinary tract erosion, complications are unavoidable and often severe, leading to removal of the device.
Unlike other surgical specialties, such as cardiovascular surgery for instance, urology is therefore characterized by the impossible long-term coexistence of the inert and its natural fluid, urine.
The first case is mainly represented by urethral or ureteral prostheses. Those devices are sources of early infections and stone obstructions. For instance, 80% of nosocomial urinary tract infections are related to the presence of a bladder catheter, which represents a major public health issue in terms of morbidity, resistance to antibiotics and financial cost.
The second case is mainly represented by devices used to cure urinary incontinence and pelvic floor disorders: urethral and promontofixation slings, periurethral balloons, artificial urinary sphincter. Those devices have a high rate of success, with low morbidity and excellent tolerance, as far as they have no contact with urine. Nevertheless, in case of urinary tract erosion, complications are unavoidable and often severe, leading to removal of the device.
Unlike other surgical specialties, such as cardiovascular surgery for instance, urology is therefore characterized by the impossible long-term coexistence of the inert and its natural fluid, urine.