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We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p p p p

Prostate surgery mainly addresses the treatment of the two most common pathologies of the prostate: benign prostatic hypertrophy (BPH), symptomatic or complicated, and prostate cancer (PCa). The objective of this manuscript was to present after review of the literature the main intraoperative and postoperative surgical complications associated with radical prostatectomy and surgery of the BPH whatever the surgical approach. The incidence and type of these complications may vary depending on the patient's comorbidities and the type of surgery. Regarding radical prostatectomy, the main complications are hemorrhagic, digestive and urinary. During or after surgery of BPH, hemorrhagic and urinary complications dominate. The management of these complications relies on general principles based on a low level of evidence, but usually associate a structured diagnostic pathway and an appropriate treatment decision.

If surgical treatment of urinary stones is indicated, the urologist has now different modalities depending on each situation. This includes extracorporeal lithotripsy, ureteroscopy (rigid and flexible), and percutaneous nephrolithotomy. Ureteroscopy is also performed for diagnostic purposes, and for the treatment of upper urinary tract tumors. Indications, as well as the steps of each of these techniques will not be discussed in this review. Only intra- and postoperative complications of ureteroscopy and percutaneous nephrolithotomy will be reviewed, including diagnostic, management, and preventive measures.

Pelvic and perineal surgeries and in particular those for stress urinary incontinence and prolapse are functional surgeries, which require careful selection of patients and assessment of discomfort to expect satisfactory surgical results and reduce failure rates and of complications. Before offering pelvic and perineal surgery, the risk of potential complications should be carefully assessed and discussed with patients. Recent attention to the potential complications prosthetic mesh has raised awareness in the urological community to report complications. This chapter will focus on the complications of surgeries used for stress urinary incontinence (synthetic retropubic or transobturator suburethral slings, colposuspension, pubovaginal slings, artificial urinary sphincter, adjustable periurethral balloons and periurethral injections of bulking agents) and sacrocolpopexies. The epidemiology of complications, the minimum assessment to be carried out, treatment and prevention will be discussed.

The first part of this article deals with accreditation of the quality of the professional practice of urologists and medical teams working in public or private health care institutions. This is a voluntary national risk management process based on the reporting and analysis of medical risk events and the development and implementation of recommendations. The fundamental objective of the system is to reduce the frequency and severity of adverse events associated with care for the patient. The second part aims to describe the mechanisms and management of surgical complications. The perception of complications by the urologist is discussed, as it may be distorted by cognitive biases leading to inappropriate actions. Two important points were also emphasized: communication with the patient following an injury, therapeutic hazard or complication following an error, and proper maintenance of the medical record. A joint effort to cultivate a culture of safety and quality in urological surgical practice should be encouraged. Collective actions by urologists in the future should help to maintain a proactive attitude: - generalization of quality accreditation of urologic physicians' professional practice; - national registry: which has demonstrated its advantages in the world of aeronautics; - creation of a specific module "Management of complications in urology" in teaching (ECU) and continuing education (SUC, website); - creation of an AFU "Complications" Committee; - management of social networks.

The management of bladder tumors is based on two major interventions, the risks of complications of which can be significant. The objective of this work is to provide an update on the complications related to bladder surgery, to detail the preventive measures and management strategies in practice.Bibliographic search using Medline bibliographic database (Pubmed) using the following keywords: transurethral resection of the bladder, cystectomy, neobladder, Bricker, complications, anastomotic strictures.Trans-urethral resection of the bladder (TURB) essentially exposes to the risk of hemorrhage (2 to 4%) and bladder perforation (1 to 3%). Total cystectomy is associated with significant morbidity and mortality, despite recent technical advances. The most frequent early complications are ileus (23 to 30%) and infectious complications (29 to 38%). Late complications included by functional complications (urinary and sexual), anastomotic strictures (7 to 12%), metabolic complications of continent derivation (25 to 46%) and stomial complications in case of non-continent derivation. The management of complications is well codified. It is however essential to anticipate and put in place preventive measures, especially for infectious and thromboembolic complications, including an exhaustive pre-operative assessment, prehabilitation of the patient and enhanced recovery after surgery.Preventing, analyzing and understanding complications in bladder surgery is essential to reduce mortality and morbidity.

The objective of this article was to summarize the means and tools of prevention and safety of care to reduce non-random surgical complications in urology, related to the care environment and the patient. The prevention of complications is an essential strategy to be applied in a standardized way in urological surgery, as in the world of aeronautics, from which we can draw valuable lessons. This prevention is multifactorial and concerns interventions, systems and human factors. The essential points listed below must be traceable: the quality of the assessment of the patient and his co-morbidities. This is a multidisciplinary task; the relevance of the surgical indication, which must take into account the state of the art at the time it is given; the expertise of the urologist and his continuing education; the relevance of the surgical indication, which must take into account the state of the art at the time it is given; the quality of the information provided to the patient and his family, and to the medical and paramedical team involved in the patient's care; the quality of the professional environment and equipment; compliance with recommended safety rules (e.g. checklist, identity check). All these points are not isolated but interdependent. They must be recorded in the patient's file, the quality and completeness of which is essential to the patient's follow-up, to the prevention and management of complications and to the understanding, if necessary, of the truth of the medical facts.

Define and present the complications of surgery of the external genitalia (EG), as well as their management.Bibliographic search using the Medline (NLM Pubmed tool) and Embase bibliographic databases using the following keywords: scrotal surgery, orchidopexy, hydrocele, varicocele, testicular biopsy, vasectomy, cryptorchidism, orchiectomy, testicular implant, subcapsular orchiectomy, spermatic cord cyst, posthectomy, penis curvature surgery, penile implant, urethral strictures.EG surgery is common in urology, it includes scrotal surgeries and penile surgeries, which are performed openly. They expose to complications such as bleeding, infection, scar disunity requiring early reassessment especially in case of ambulatory procedure. Rare complications must be known, some of which must lead to expert management.Complications of surgical treatment of EG should be identified and managed. This report should allow a better understanding and management of these complications.

The objective of this article was to discuss the statistics of surgical complications in urology and the methods of collection and classification. In the absence of a comprehensive national registry of complications, we used statistics from insurance companies as indicators. They are limited by the exclusion of complications that did not result in a claim. Overall, urology is less exposed to claims than other surgical specialties. It comes far behind orthopedic surgery, gynecology-obstetrics and visceral surgery. The new techniques in urological surgery and in particular the rise of robotic surgery do not seem to have modified the number of claims handled by medical insurance companies. It is unfortunate that complications in urological surgery are not collected, reported, and discussed in order to develop prevention, treatment, and strategies for educational purposes. The lack of an established definition and classification of surgical complications, as well as methodological differences in the collection of related information, has hampered the evaluation of their public health and health economics impact. Awareness of this problem is growing among learned societies and practitioners. Complication reporting should be organized on a national basis and should respect the following points: - definition of the collection process according to a validated system. For urology, the Martin table revised by the EAU working group would be adapted; - classification of complications according to a validated system such as Clavien-Dindo or CCI.

Delayed graft function (DGF) is a common complication after transplantation of deceased donor kidneys. The aim of this study was to investigate the feasibility of using computed tomography texture analysis (CT-TA) of the donor kidney to predict delayed graft function (DGF) following kidney transplantation from cadaveric donors.We made a retrospective review of all consecutive DBD and DCD kidney donors admitted to our institution and their corresponding KTRs between December 2014 and January 2019. We extracted 15 image features from unenhanced CT and contrast-enhanced CT corresponding to first order and second order Haralick textural features. Predictors of DGF were evaluated by univariable and multivariable analysis. Receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) to predict DGF was calculated for the predictors.A total of 115 patients were included in the study. DGF occurred in 15 patients (13%). Recipient body mass index (BMI) (P=0.003) and Skewness (P=0.05) represented independent predictors in the multivariate model. The combination of both clinical and textural features in a bivariate model reached a ROC-AUC of 0.79 (95% CI: 0.64-0.94) in predicting the probability of DGF.Results from this preliminary study suggest that CT texture analysis might be a promising quantitative imaging tool to help physician predict DFG after kidney transplantation from cadaveric donors.4/5.