Access, diagnostic and drainage
Lower- and upper-tract access, investigation, temporary drainage and device care.
Flexible cystoscopy
Urinary infection or sepsis
Lower-tract instrumentation can introduce or disseminate infection, especially when drainage is impaired or bacteriuria is present.
Applies to: Diagnostic flexible cystoscopy · Flexible surveillance cystoscopy · Flexible cystoscopy with stent retrievalUrethral trauma or false passage
Forced passage, poor visualisation or an unrecognised stricture can injure the urethra.
Applies to: Diagnostic flexible cystoscopy · Flexible surveillance cystoscopy · Flexible cystoscopy with stent retrievalHaematuria and dysuria
Minor mucosal trauma may cause short-lived bleeding or discomfort; persistent symptoms require a different explanation.
Applies to: Diagnostic flexible cystoscopy · Flexible surveillance cystoscopy · Flexible cystoscopy with stent retrievalFailed or incomplete examination
A stricture, pain, bleeding, poor visibility or bladder anatomy may prevent a complete diagnostic survey.
Applies to: Diagnostic flexible cystoscopy · Flexible surveillance cystoscopy · Flexible cystoscopy with stent retrievalDevice retrieval injury or failure
An encrusted, migrated or trapped device may not be safely removable through the flexible scope and traction can injure the ureter or urethra.
Applies to: Flexible cystoscopy with stent retrievalMissed mucosal lesion
Incomplete distension, poor visibility or subtle morphology can leave clinically important urothelial disease undetected.
Applies to: Diagnostic flexible cystoscopy · Flexible surveillance cystoscopyPercutaneous nephrostomy insertion and exchange
Haemorrhage or vascular injury
The tract may injure renal parenchymal or segmental vessels, producing haematuria, perirenal bleeding or a later vascular lesion.
Applies to: Ultrasound-guided nephrostomy · Fluoroscopic nephrostomy · Combined ultrasound and fluoroscopy · Nephrostogram and tube exchangePleural injury, hydrothorax or pneumothorax
A high intercostal tract may traverse pleura or diaphragm and cause respiratory compromise or fluid in the chest.
Applies to: Ultrasound-guided nephrostomy · Fluoroscopic nephrostomy · Combined ultrasound and fluoroscopyVisceral injury
Colon and solid organs may lie in the proposed tract, particularly with unusual anatomy or previous surgery.
Applies to: Ultrasound-guided nephrostomy · Fluoroscopic nephrostomy · Combined ultrasound and fluoroscopyUrinary infection or sepsis
Puncture, contrast injection or impaired drainage in an infected obstructed system can precipitate systemic illness.
Applies to: Ultrasound-guided nephrostomy · Fluoroscopic nephrostomy · Combined ultrasound and fluoroscopy · Nephrostogram and tube exchangeUrine extravasation or perinephric collection
A displaced or poorly draining tube can leak urine outside the collecting system.
Applies to: Ultrasound-guided nephrostomy · Fluoroscopic nephrostomy · Combined ultrasound and fluoroscopy · Nephrostogram and tube exchangeTube displacement, blockage or disconnection
Loss of secure external drainage may recreate obstruction, leak or infection and can result in tract loss.
Applies to: Ultrasound-guided nephrostomy · Fluoroscopic nephrostomy · Combined ultrasound and fluoroscopy · Nephrostogram and tube exchangeFailure to gain or retain access
A non-dilated system, difficult anatomy or wire displacement can make safe tube placement impossible.
Applies to: Ultrasound-guided nephrostomy · Fluoroscopic nephrostomy · Combined ultrasound and fluoroscopy · Nephrostogram and tube exchangeRetrograde pyelography and ureteric stent procedures
Ureteric perforation or false passage
A wire, catheter or pressurised injection can leave the ureteric lumen, particularly at an impacted obstruction.
Applies to: Retrograde pyelogram alone · Primary retrograde JJ stent insertion · Ureteric stent exchangeUrinary infection or sepsis
Instrumentation of an infected or obstructed system can precipitate systemic infection; a blocked stent may fail to drain.
Applies to: Retrograde pyelogram alone · Primary retrograde JJ stent insertion · Ureteric stent exchange · Ureteric stent removalFailure to obtain retrograde access
A tight obstruction, distorted orifice or loss of access may prevent safe passage and require an alternative drainage route.
Applies to: Retrograde pyelogram alone · Primary retrograde JJ stent insertion · Ureteric stent exchangeStent malposition or migration
Incorrect length, incomplete coil formation or later movement can impair drainage and injure the tract.
Applies to: Primary retrograde JJ stent insertion · Ureteric stent exchangeStent symptoms, haematuria or reflux pain
An internal stent may cause frequency, urgency, flank discomfort and visible bleeding despite adequate position.
Applies to: Primary retrograde JJ stent insertion · Ureteric stent exchangeEncrustation, blockage or forgotten stent
Delayed removal increases mineral deposition, infection, obstruction and the complexity of eventual retrieval.
Applies to: Primary retrograde JJ stent insertion · Ureteric stent exchangeUreteric avulsion during removal
Forceful extraction of an encrusted, knotted or trapped stent can cause major ureteric injury.
Applies to: Ureteric stent removalRigid cystoscopy, bladder biopsy and fulguration
Urinary infection or sepsis
Lower-tract instrumentation can introduce or disseminate infection, particularly when drainage is impaired.
Applies to: Rigid diagnostic cystoscopy · Targeted cold-cup biopsy · Mapping biopsy · Limited bladder fulgurationUrethral trauma or later stricture
A rigid sheath can injure a narrow or angulated urethra, with acute bleeding or later narrowing.
Applies to: Rigid diagnostic cystoscopy · Targeted cold-cup biopsy · Mapping biopsy · Limited bladder fulgurationHaematuria or clot retention
Biopsy sites or incomplete haemostasis can bleed and clot may obstruct bladder drainage.
Applies to: Targeted cold-cup biopsy · Mapping biopsy · Limited bladder fulgurationBladder perforation
Deep sampling, instrument movement, coagulation or work in a diverticulum can breach the bladder wall.
Applies to: Rigid diagnostic cystoscopy · Targeted cold-cup biopsy · Mapping biopsy · Limited bladder fulgurationUreteric-orifice injury or obstruction
Sampling or coagulation close to an orifice can impair drainage or cause reflux-related consequences.
Applies to: Targeted cold-cup biopsy · Mapping biopsy · Limited bladder fulgurationInadequate, damaged or mislabelled tissue
Small, crushed, cauterised or poorly mapped specimens can limit diagnosis and undermine subsequent treatment decisions.
Applies to: Targeted cold-cup biopsy · Mapping biopsySuprapubic catheter insertion and exchange
Bowel or intraperitoneal injury
An intervening viscus or a high peritoneal reflection may be entered, with presentation ranging from immediate concern to delayed peritonitis.
Applies to: Percutaneous trocar SPC · Seldinger SPC · Open SPCBleeding or abdominal-wall haematoma
The tract may injure abdominal-wall or bladder vessels, particularly when access is off midline or difficult.
Applies to: Percutaneous trocar SPC · Seldinger SPC · Open SPC · Mature-tract SPC exchangeUrinary infection or sepsis
Bacteriuria, instrumentation and impaired drainage can progress from local infection to systemic illness.
Applies to: Percutaneous trocar SPC · Seldinger SPC · Open SPC · Mature-tract SPC exchangeCatheter outside the bladder
Loss of the tract or failure to confirm bladder entry can result in extravesical balloon inflation and absent drainage.
Applies to: Percutaneous trocar SPC · Seldinger SPC · Mature-tract SPC exchangeTract loss during exchange
A suprapubic tract can narrow rapidly after removal; early or difficult exchange may create a false passage.
Applies to: Mature-tract SPC exchangeBlockage, encrustation and bladder stones
Long-term catheter biofilm and mineral deposition can impair drainage and contribute to recurrent stones.
Applies to: Percutaneous trocar SPC · Seldinger SPC · Open SPC · Mature-tract SPC exchangePersistent leakage or tract problems
Bypassing, granulation, skin irritation or failure of the tract to close may complicate ongoing care or removal.
Applies to: Percutaneous trocar SPC · Seldinger SPC · Open SPC · Mature-tract SPC exchangeTransperineal prostate biopsy
Acute urinary retention
Prostatic swelling, bleeding and baseline outlet obstruction can impair voiding, with risk increasing as sampling becomes more extensive.
Applies to: Freehand transperineal biopsy · Grid-based template biopsy · MRI-targeted biopsy · Transperineal mapping biopsyHaematuria, haematospermia or perineal bleeding
Needle tracks commonly produce self-limited urinary, seminal or perineal bleeding but may occasionally form a significant haematoma.
Applies to: Freehand transperineal biopsy · Grid-based template biopsy · MRI-targeted biopsy · Transperineal mapping biopsyUrinary infection or sepsis
The transperineal route reduces rectal contamination but urinary and systemic infection remain possible.
Applies to: Freehand transperineal biopsy · Grid-based template biopsy · MRI-targeted biopsy · Transperineal mapping biopsyPain, bruising or sensory disturbance
Multiple perineal punctures and positioning may cause short-term discomfort, bruising or altered sensation.
Applies to: Freehand transperineal biopsy · Grid-based template biopsy · MRI-targeted biopsy · Transperineal mapping biopsyNon-diagnostic or false-negative sampling
Targeting error, inadequate core distribution or specimen-labelling problems can miss or mislocalise clinically important disease.
Applies to: Freehand transperineal biopsy · Grid-based template biopsy · MRI-targeted biopsy · Transperineal mapping biopsyUrethral catheterisation and difficult urethral access
False passage or urethral perforation
Resistance, repeated blind attempts, misdirected specialist tips or a wire outside the true lumen can injure the urethra.
Applies to: Standard transurethral catheter · Coude or specialist-tip catheter · Guidewire-assisted catheterisation · Cystoscopic catheterisationBalloon inflation in the urethra
Failure to establish intravesical position before inflation can cause pain, bleeding, obstruction and significant urethral injury.
Applies to: Standard transurethral catheter · Coude or specialist-tip catheter · Guidewire-assisted catheterisationCatheter-associated urinary infection
Instrumentation and duration of catheterisation create infection risk, especially with breaks in the closed drainage system.
Applies to: Standard transurethral catheter · Coude or specialist-tip catheter · Guidewire-assisted catheterisation · Cystoscopic catheterisationHaematuria and urethral bleeding
Mucosal trauma may produce bleeding and can obscure whether a false passage has occurred.
Applies to: Standard transurethral catheter · Coude or specialist-tip catheter · Guidewire-assisted catheterisation · Cystoscopic catheterisationBypassing, blockage or failed drainage
Kinking, debris, clot, malposition or an inappropriate catheter can prevent effective bladder decompression.
Applies to: Standard transurethral catheter · Coude or specialist-tip catheter · Guidewire-assisted catheterisation · Cystoscopic catheterisationLater urethral stricture
Urethral trauma and prolonged catheter pressure may heal with narrowing and recurrent obstructive symptoms.
Applies to: Standard transurethral catheter · Coude or specialist-tip catheter · Guidewire-assisted catheterisation · Cystoscopic catheterisationUrodynamic investigation
Urinary infection
Transurethral catheterisation can provoke symptomatic urinary infection after testing.
Applies to: Conventional filling cystometry · Pressure-flow study · Video urodynamics · Ambulatory urodynamicsUrethral discomfort or minor bleeding
Small diagnostic catheters can cause transient pain, dysuria or mucosal trauma.
Applies to: Conventional filling cystometry · Pressure-flow study · Video urodynamics · Ambulatory urodynamicsTransient retention or inability to void
Instrumentation, anxiety, position and underlying dysfunction may prevent representative voiding or precipitate short-lived retention.
Applies to: Pressure-flow study · Video urodynamicsAutonomic dysreflexia
Susceptible patients with neurological lesions may develop a dangerous autonomic response to filling or instrumentation.
Applies to: Conventional filling cystometry · Pressure-flow study · Video urodynamics · Ambulatory urodynamicsMisleading or non-diagnostic study
Artefact, non-physiological filling, absent symptom reproduction or poor-quality signals may support an incorrect mechanism.
Applies to: Conventional filling cystometry · Pressure-flow study · Video urodynamics · Ambulatory urodynamicsContrast or radiation-related burden
Fluoroscopy introduces ionising radiation and contrast-specific considerations that do not apply to pressure-only studies.
Applies to: Video urodynamics