Transplant and highly specialised reconstruction
Tertiary oncological, transplant, reconstructive and genital procedures retained for completeness.
Adrenalectomy
Major vascular bleeding
Short adrenal veins and proximity to the vena cava, renal vessels and aorta can produce difficult haemorrhage.
Applies to: All variantsHaemodynamic or endocrine crisis
Hormone release or abrupt hormone deficiency can cause major physiological instability.
Applies to: All variantsPancreatic, splenic, hepatic, bowel or renal injury
The at-risk adjacent organ differs by side and approach.
Applies to: All variantsPleural injury or pneumothorax
High retroperitoneal or posterior dissection can breach the diaphragm or pleura.
Applies to: All variantsAdrenal insufficiency
Insufficient residual cortex or bilateral disease can leave a need for long-term endocrine replacement.
Applies to: Cortical-sparing partial adrenalectomyPositive margin, tumour spill or local recurrence
Oncological quality depends on intact en bloc removal when malignancy is suspected.
Applies to: Open oncological adrenalectomy · Laparoscopic transperitoneal adrenalectomy · Robotic adrenalectomyConversion or access-site complication
Bleeding, invasion or limited working space may require a larger incision and creates port-specific risks.
Applies to: Laparoscopic transperitoneal adrenalectomy · Posterior retroperitoneoscopic adrenalectomy · Robotic adrenalectomyComplex ureteric replacement
Urinary leak or fistula
Long reconstruction and substitution-tissue joins create several potential leakage points.
Applies to: All variantsRecurrent stricture, kinking or obstruction
Anastomotic scarring, graft contraction or conduit geometry can impair drainage.
Applies to: All variantsInfection or sepsis
Devices, stasis, bowel colonisation and leakage can produce systemic infection.
Applies to: All variantsBowel leak, obstruction or nutritional impact
Bowel isolation adds anastomotic, adhesive and absorption consequences.
Applies to: Ileal ureter substitution · Combined or bilateral substitutionMucus, stone or metabolic disturbance
Urine contact with bowel causes mucus production and solute exchange.
Applies to: Ileal ureter substitution · Combined or bilateral substitutionGraft contraction or oral donor-site morbidity
Substitution mucosa can contract, while harvest causes pain, numbness or tightness.
Applies to: Buccal mucosal graft ureteroplastyVascular thrombosis and renal loss
Autotransplant introduces arterial and venous anastomoses whose failure can sacrifice the kidney.
Applies to: Renal autotransplantationReduced renal function or nephrectomy
Persistent obstruction, infection or vascular injury can defeat the nephron-preserving objective.
Applies to: All variantsContinent cutaneous urinary diversion
Bowel leak, obstruction or intra-abdominal sepsis
Bowel isolation and anastomosis carry immediate and adhesive late risks.
Applies to: All variantsUrinary leak or reservoir perforation
Anastomotic failure can occur early, while a mature reservoir can rupture years later.
Applies to: All variantsStomal or channel stenosis and catheterisation failure
Narrowing, angulation, false passage or valve failure can threaten dependable emptying.
Applies to: All variantsReservoir or stomal incontinence
High pressure or failure of the continence mechanism can cause leakage.
Applies to: All variantsUreteroenteric stricture and renal deterioration
Ischaemic anastomotic scarring can silently obstruct an upper tract.
Applies to: All variantsInfection, mucus obstruction or stones
Bowel mucus, bacteriuria, foreign material and incomplete emptying promote blockage and calculi.
Applies to: All variantsMetabolic, nutritional or drug-handling disturbance
Urine–bowel contact changes acid-base balance and solute handling.
Applies to: All variantsMalignancy in the reservoir or anastomosis
Bowel incorporated into the urinary tract carries a long-term tumour surveillance consideration.
Applies to: All variantsDeceased-donor kidney and multiorgan retrieval
Renal artery or vein injury and unusable graft
Unrecognised vascular variation or hurried division can shorten or damage essential vessels.
Applies to: All variantsUreteric devascularisation
Stripping peri-ureteric tissue can cause later transplant ureter necrosis.
Applies to: All variantsInadequate perfusion or prolonged ischaemia
Delay, cannula malposition or flush failure can compromise graft function.
Applies to: All variantsInjury to another donated organ
Multiorgan dissection requires shared planes and explicit coordination.
Applies to: All variantsUnrecognised tumour, infection or anatomical abnormality
Missed donor pathology can affect recipient safety and organ allocation.
Applies to: All variantsIdentification, laterality or packaging error
Chain-of-custody and graft-specific communication are safety-critical procedural elements.
Applies to: All variantsTeam sharps, fluid or occupational exposure
Retrieval conditions can create occupational hazards requiring established protocols.
Applies to: All variantsFocal ablation for localised prostate cancer
Urinary retention, slough or bladder-outlet obstruction
Tissue swelling and later necrotic debris can obstruct the urethra.
Applies to: All variantsUrinary infection or sepsis
Transrectal/transperineal access and necrotic tissue can become infected.
Applies to: All variantsRectourethral fistula or rectal injury
Energy spread into the rectal wall can cause a severe delayed fistula.
Applies to: All variantsUrethral stricture or bladder-neck stenosis
Thermal or cold injury can heal by fibrosis.
Applies to: All variantsUrinary incontinence
Sphincter or outlet injury can cause stress or urgency leakage.
Applies to: All variantsErectile or ejaculatory dysfunction
Neurovascular and gland treatment can alter erection, ejaculation and fertility.
Applies to: All variantsResidual, recurrent or out-of-field cancer
Focal treatment does not remove the gland and depends on rigorous whole-gland surveillance.
Applies to: All variantsSalvage-healing complication
Previously irradiated or ablated tissue has greater risks of necrosis, fistula and poor healing.
Applies to: Salvage focal ablationGender-affirming feminising urogenital reconstruction
Rectal injury or rectovaginal fistula
Deep canal creation or revision can enter the rectum and cause severe delayed fistula.
Applies to: Penile-inversion vaginoplasty · Peritoneal flap vaginoplasty · Bowel vaginoplasty · Revision vaginoplasty or urethral revisionUrethral injury, fistula or meatal stenosis
Relocation and shortening can leak, scar or produce urinary spraying and recurrent infection.
Applies to: All variantsBleeding, pelvic collection or infection
Large pelvic and perineal wounds can conceal haemorrhage and become infected.
Applies to: All variantsSkin, flap, clitoral or canal necrosis
Tissue tension or compromised pedicles can cause partial loss and sensory injury.
Applies to: All variantsVaginal stenosis, loss of depth or prolapse
Scar, inadequate tissue, dilation difficulty or apical support failure can alter canal dimensions.
Applies to: Penile-inversion vaginoplasty · Peritoneal flap vaginoplasty · Bowel vaginoplasty · Revision vaginoplasty or urethral revisionUrinary incontinence, retention or recurrent infection
Outlet dissection, changed flow direction and pelvic-floor effects can alter urinary function.
Applies to: All variantsBowel leak, mucus, malodour or diversion colitis
Bowel substitution adds anastomotic and lifelong mucosal consequences.
Applies to: Bowel vaginoplastyAltered sensation, sexual pain or inability to achieve intended sexual function
Sensory and sexual outcomes depend on nerve preservation, healing, dimensions and individual goals.
Applies to: All variantsGender-affirming masculinising urogenital reconstruction
Partial or total flap loss
Arterial thrombosis, venous congestion or tissue compromise can threaten the phallus and requires time-critical recognition.
Applies to: Radial-forearm free-flap phalloplasty · Anterolateral-thigh or other flap phalloplastyUrethral fistula, leak or stricture
Long multi-segment urethral construction has several vulnerable joins and blood-supply transitions.
Applies to: All variantsUrinary retention, spraying or inability to void standing
Patency, geometry and continence can limit the intended urinary outcome.
Applies to: All variantsWound infection, dehiscence or pelvic collection
Large composite wounds and urinary contamination can compromise healing.
Applies to: All variantsDonor-site functional, sensory or cosmetic morbidity
Flap harvest can affect limb strength, sensation, scarring and graft healing.
Applies to: Radial-forearm free-flap phalloplasty · Anterolateral-thigh or other flap phalloplastyAltered or absent erotic/tactile sensation and pain
Nerve coaptation and native-tissue preservation do not guarantee sensory outcomes.
Applies to: All variantsTesticular or penile prosthesis infection, erosion or failure
Implants in reconstructed tissue have device-specific revision risks.
Applies to: Scrotoplasty and testicular prostheses · Penile prosthesis and revisionDissatisfaction or psychological distress
Staging, complications and outcome variability require sustained, person-centred support.
Applies to: All variantsInguinal and pelvic nodal surgery for penile cancer
Skin-flap necrosis or wound breakdown
Groin skin perfusion is vulnerable after open flap elevation.
Applies to: Modified or radical open inguinal lymphadenectomyLymphocele, lymphorrhoea or leg/genital lymphoedema
Extensive lymphatic division can cause persistent collections and long-term swelling.
Applies to: All variantsWound or deep infection
Groin moisture, lymph leakage and skin compromise increase infection risk.
Applies to: All variantsFemoral or iliac vascular injury and thrombosis
Nodal tissue can be adherent to major vessels, especially with bulky disease.
Applies to: All variantsNerve injury, numbness or chronic pain
Sensory branches and the femoral/obturator nerves are exposed during dissection.
Applies to: All variantsPort, gas-space or conversion complication
Minimally invasive groin access creates distinct subcutaneous-space and conversion risks.
Applies to: Video-endoscopic or robotic inguinal lymphadenectomyFalse-negative staging or incomplete nodal clearance
Mapping failure, missed basins or inadequate template can delay recognition of disease.
Applies to: All variantsKidney-sparing endoscopic treatment of upper-tract urothelial carcinoma
Ureteric perforation, extravasation or later stricture
Deep energy or access trauma can breach and later narrow the ureter.
Applies to: Ureteroscopic laser ablation · Antegrade ureteroscopic treatmentBleeding or renal vascular injury
Percutaneous tract and tumour resection can cause collecting-system or parenchymal haemorrhage.
Applies to: Percutaneous resection or ablation · Antegrade ureteroscopic treatmentInfection or sepsis
Instrumentation, pressure and temporary drainage can cause systemic infection.
Applies to: All variantsAdjacent-organ or pleural injury
Percutaneous access can traverse pleura, bowel, liver or spleen.
Applies to: Percutaneous resection or ablation · Antegrade ureteroscopic treatmentResidual, recurrent or understaged tumour
Sampling limitations and field change make recurrence and progression central to this pathway.
Applies to: All variantsTumour seeding along a tract
Percutaneous access creates a rare route for extra-urinary implantation.
Applies to: Percutaneous resection or ablation · Antegrade ureteroscopic treatmentChemical inflammation, obstruction or systemic exposure
Local treatment can leak, inflame or obstruct the upper tract and has agent-specific systemic risks.
Applies to: Adjuvant upper-tract instillation pathwayLiving-donor nephrectomy
Major vascular injury or haemorrhage
Healthy donors can sustain life-threatening injury to renal vessels, aorta, vena cava or branches.
Applies to: All variantsBowel, pancreatic, splenic, hepatic or pleural injury
Upper abdominal dissection and access can injure adjacent organs.
Applies to: All variantsConversion to open surgery
Bleeding, anatomy or graft-safety concern may necessitate rapid open exposure.
Applies to: Transperitoneal laparoscopic donor nephrectomy · Hand-assisted laparoscopic donor nephrectomy · Robotic donor nephrectomyVenous thromboembolism, cardiopulmonary event or death
Even a carefully selected healthy donor faces rare serious perioperative harms.
Applies to: All variantsWound pain, hernia, neuropathy or chronic symptoms
Extraction and flank/port wounds can have durable effects.
Applies to: All variantsReduced kidney function or later hypertension
Nephrectomy permanently reduces nephron mass and requires long-term donor follow-up.
Applies to: All variantsGraft vessel, ureter or parenchymal injury
Excess traction, short division or thermal injury can compromise the donated organ.
Applies to: All variantsPrimary-tumour surgery for penile cancer
Bleeding, infection or graft loss
Penile excision and reconstruction can produce haematoma, contamination and partial or complete graft failure.
Applies to: All variantsUrethral leak, fistula or meatal stenosis
The reconstructed urinary outlet can break down or scar.
Applies to: All variantsFlap, glans or stump ischaemia
Extensive resection can compromise the remaining blood supply.
Applies to: All variantsPositive margin or local recurrence
Organ preservation requires pathology-led review and structured local surveillance.
Applies to: All variantsUrinary spraying, sitting to void or outlet-care difficulty
Altered urethral position and calibre affect urinary function.
Applies to: Partial penectomy · Total penectomy with perineal urethrostomy · Salvage or recurrent-tumour excisionSexual, sensory, body-image and psychological morbidity
Functional and emotional consequences vary substantially by the amount of organ preserved.
Applies to: All variantsDonor-site morbidity
Skin-graft harvest creates an additional wound and scar.
Applies to: Wide local excision or glans resurfacing · Glansectomy with neoglans reconstructionProstatic artery embolisation pathway
Non-target embolisation
Embolic material can injure bladder, rectum, penis, skin or other pelvic organs through collateral vessels.
Applies to: All variantsAccess-site bleeding, pseudoaneurysm or arterial injury
Femoral or radial access and selective catheterisation can injure vessels.
Applies to: All variantsPost-embolisation pain and systemic inflammatory symptoms
Ischaemic prostate tissue can produce pelvic symptoms and systemic malaise.
Applies to: All variantsUrinary retention or infection
Swelling and pre-existing obstruction can impair voiding and increase infection risk.
Applies to: All variantsContrast-related kidney or allergic complication
Angiography introduces contrast-specific renal and hypersensitivity risks.
Applies to: All variantsErectile, ejaculatory or penile ischaemic dysfunction
Intended and unintended vascular changes can affect sexual function.
Applies to: All variantsIncomplete response, recurrence or retreatment
Technical success does not guarantee durable symptom and flow improvement.
Applies to: All variantsRecipient kidney transplantation
Renal artery or vein thrombosis
Early graft-vessel thrombosis can cause abrupt allograft loss and requires time-critical recognition.
Applies to: All variantsMajor haemorrhage or anastomotic disruption
Recipient or graft vessels can bleed during or after implantation.
Applies to: All variantsUreteric leak, necrosis or stricture
Compromised graft-ureter blood supply or anastomotic issues can cause leakage or obstruction.
Applies to: All variantsLymphocele or lymphatic leak
Recipient iliac lymphatic division can produce a compressive or infected collection.
Applies to: All variantsDelayed graft function or primary non-function
Ischaemia–reperfusion injury, donor quality and technical factors can delay or prevent graft function.
Applies to: All variantsRejection, infection or immunosuppression-related morbidity
Surgical recovery occurs within a lifelong immunological and infectious-risk pathway.
Applies to: All variantsIliac-vessel thrombosis or limb ischaemia
Clamping, dissection or anastomosis can compromise recipient lower-limb circulation.
Applies to: All variantsBowel, bladder or adjacent-organ injury
Prior surgery and intraperitoneal placement increase adjacent-organ risk.
Applies to: All variantsRenal allograft biopsy
Perigraft haematoma or major haemorrhage
A biopsy tract can injure arterial or venous branches and occasionally require transfusion or intervention.
Applies to: All variantsArteriovenous fistula or pseudoaneurysm
Paired vessel injury can create a persistent vascular lesion.
Applies to: All variantsMacroscopic haematuria or ureteric obstruction by clot
Communication with the collecting system can cause bleeding and impaired graft drainage.
Applies to: All variantsInfection
Needle or surgical access can seed a graft or surrounding collection in an immunosuppressed patient.
Applies to: All variantsBowel, bladder or iliac-vessel injury
An atypical graft position or unsafe trajectory can injure adjacent structures.
Applies to: All variantsInadequate, crushed or misallocated specimen
Sampling and laboratory triage failure can make an invasive procedure non-diagnostic.
Applies to: All variantsGraft dysfunction or loss
Severe bleeding, obstruction or vascular injury can impair the transplanted kidney.
Applies to: All variantsRenal autotransplantation and ex vivo repair
Arterial or venous thrombosis and renal loss
Multiple reconstructed vessels and cold-ischaemia exposure can lead to early graft failure.
Applies to: All variantsMajor haemorrhage or vascular anastomotic disruption
Both nephrectomy and reimplantation create major vascular risk.
Applies to: All variantsUrinary leak or ureteric obstruction
Bench collecting-system repair and new urinary anastomosis can leak or scar.
Applies to: All variantsIschaemic renal dysfunction
Warm/cold ischaemia, perfusion and branch reconstruction affect renal recovery.
Applies to: All variantsBowel, solid-organ or iliac-vessel injury
The operation combines upper-abdominal nephrectomy and pelvic transplant exposures.
Applies to: All variantsInfection, lymphocele or wound complication
Two operative fields and iliac lymphatic dissection increase wound and collection morbidity.
Applies to: All variantsPersistent pain or failure of indication-specific benefit
Technically successful reimplantation may not achieve the intended pain outcome.
Applies to: Autotransplant for selected pain syndromeResidual or recurrent tumour
Bench excision must maintain margin quality and surveillance despite maximal preservation intent.
Applies to: Ex vivo tumour excisionRenal tumour ablation
Perirenal bleeding or vascular injury
Probe passage and tissue necrosis can cause haematoma, pseudoaneurysm or active haemorrhage.
Applies to: All variantsCollecting-system injury, urine leak or ureteric stricture
Central treatment or heat/cold spread can injure urothelium and impair drainage.
Applies to: All variantsBowel or adjacent-organ thermal injury
An insufficient protective window can transmit energy beyond the kidney.
Applies to: All variantsPleural injury or pneumothorax
An upper-pole percutaneous trajectory may traverse or irritate the pleura.
Applies to: All variantsInfection or abscess
Necrotic tissue and urinary communication can become infected.
Applies to: All variantsResidual viable tumour or local recurrence
Incomplete treatment requires imaging recognition and may prompt repeat ablation or surgery.
Applies to: All variantsCold- or heat-specific skin and nerve injury
Energy can injure the abdominal wall, psoas or nearby sensory and motor nerves.
Applies to: All variantsRenal vein and inferior vena cava tumour thrombectomy
Massive haemorrhage
Caval, hepatic, lumbar or collateral-vessel injury can produce rapid life-threatening blood loss.
Applies to: All variantsTumour or bland-thrombus embolisation
Thrombus manipulation can send material to the pulmonary circulation or heart.
Applies to: All variantsCaval thrombosis, stenosis or lower-body oedema
Reconstruction or ligation can impair venous return and threaten the contralateral renal vein.
Applies to: All variantsHepatic or cardiac injury and organ failure
High-level exposure and circulatory control can injure liver, hepatic veins, diaphragm or heart.
Applies to: Retrohepatic caval thrombectomy · Suprahepatic or atrial thrombectomyAcute kidney injury
Nephrectomy, venous control, blood loss and haemodynamic instability stress the remaining kidney.
Applies to: All variantsNeurological, coagulopathic or bypass-related event
Complex circulatory support adds neurological, inflammatory and coagulation risks.
Applies to: Suprahepatic or atrial thrombectomyPositive vascular margin or tumour spill
Thrombus fragmentation or unrecognised wall invasion can compromise oncological clearance.
Applies to: All variantsDeath or prolonged critical illness
This is a major multiorgan operation with a recognised risk of severe postoperative morbidity.
Applies to: All variantsRetroperitoneal lymph-node dissection
Major vascular bleeding or thrombosis
Dissection from great vessels and fibrotic post-treatment masses can require vascular repair or reconstruction.
Applies to: All variantsBowel, pancreatic, ureteric or renal injury
Adjacent organs may be injured or require planned en bloc excision.
Applies to: All variantsChylous leak or chylous ascites
Lymphatic disruption can cause persistent high-output drainage or abdominal collection.
Applies to: All variantsEjaculatory dysfunction
Sympathetic nerve injury can impair emission despite preserved erection.
Applies to: All variantsIleus, bowel obstruction or abdominal wound morbidity
Extensive retroperitoneal exposure affects bowel recovery and creates adhesion or incisional risks.
Applies to: All variantsPort-site or conversion complication
Minimally invasive access adds port injury and the possibility of unplanned open conversion.
Applies to: Laparoscopic or robotic RPLNDIncomplete template or residual viable tumour
Oncological quality depends on complete indicated resection without violating masses.
Applies to: All variantsSalvage pelvic oncology and pelvic exenteration
Massive haemorrhage and vascular reconstruction complication
Scarred pelvic vessels and planned sidewall resection can cause major bleeding, thrombosis or limb ischaemia.
Applies to: All variantsUrinary or bowel anastomotic leak and fistula
Multiple joins in irradiated or malnourished tissue can break down and cross-communicate.
Applies to: All variantsPelvic abscess, sepsis or empty-pelvis complication
Large dead space and contaminated organ systems predispose to deep infection and bowel descent.
Applies to: All variantsWound or flap failure
Perineal and abdominal closure may fail in previously treated tissue.
Applies to: All variantsRenal, respiratory or multiorgan failure
Long complex surgery, blood loss and infection can lead to prolonged critical illness.
Applies to: All variantsNerve injury, pain or loss of lower-limb/pelvic function
Sidewall and sacral dissection can affect gait, pelvic function and chronic pain.
Applies to: All variantsPositive margin or early recurrence
The value of extreme surgery depends on achieving the agreed oncological objective.
Applies to: All variantsPermanent urinary, bowel and sexual-function change
Diversions and organ loss create substantial lifelong functional and body-image consequences.
Applies to: All variantsTransplant nephrectomy
Catastrophic iliac-vessel haemorrhage
Dense scarring and infected vascular stumps can cause intraoperative or delayed arterial/venous disruption.
Applies to: All variantsRetained infected tissue or pelvic abscess
Subcapsular removal may leave capsule or material that can remain infected.
Applies to: All variantsBladder, bowel or adjacent-organ injury
Reoperative inflammatory planes obscure nearby structures.
Applies to: All variantsVenous thrombosis or limb ischaemia
Iliac vessel manipulation and repair can compromise lower-limb circulation.
Applies to: All variantsWound breakdown or incisional hernia
Immunosuppression, infection and repeated iliac-fossa access impair wound healing.
Applies to: All variantsHLA sensitisation affecting future transplantation
Allograft removal and immunosuppression change can influence future donor compatibility.
Applies to: All variantsPost-embolisation pain, fever or non-target injury
Endovascular devascularisation creates an inflammatory syndrome and can affect adjacent circulation.
Applies to: Allograft embolisationTransplant ureteric reconstruction
Graft vascular injury and haemorrhage
The urinary reconstruction lies close to superficially placed transplant vessels.
Applies to: All variantsPersistent urinary leak or fistula
Ischaemic tissue or a failed anastomosis can continue to leak.
Applies to: All variantsRecurrent stricture and graft obstruction
Scar, tension and continuing ischaemia can compromise the revision.
Applies to: All variantsUrinary infection or sepsis
Obstruction, leak, devices and immunosuppression amplify infection risk.
Applies to: All variantsLoss of graft function or graft loss
Delayed or unsuccessful drainage can irreversibly damage the allograft.
Applies to: All variantsBowel or bladder injury
Reoperative pelvic planes can be densely adherent.
Applies to: Repeat ureteroneocystostomy · Native ureteropyelostomy or ureteroureterostomy · Boari flap, bowel substitution or complex urinary reconstructionStent or nephrostomy complication
Temporary devices can displace, block, encrust or be overlooked.
Applies to: Endoscopic or percutaneous treatmentTreatment of transplant lymphocele and perigraft collections
Graft, ureteric or iliac-vessel injury
Needle, trocar or dissection close to the graft can cause bleeding, urine leak or loss of perfusion.
Applies to: All variantsBowel injury or internal herniation
Operative entry and a peritoneal window can injure or later trap bowel.
Applies to: Laparoscopic or robotic fenestration · Open drainage and revisionInfection or abscess
An initially sterile collection can become infected after instrumentation.
Applies to: All variantsPersistent drainage or recurrence
A narrow window or continuing lymphatic source can recreate the collection.
Applies to: All variantsChemical injury or systemic reaction
Sclerosant can leak, inflame adjacent tissues or cause agent-specific systemic effects.
Applies to: Percutaneous sclerotherapyMissed urinary leak or misclassified collection
Treating a urinoma as a lymphocele delays repair of the actual urinary complication.
Applies to: All variantsGraft dysfunction from persistent compression
Incomplete treatment can continue to obstruct the ureter or compromise renal perfusion.
Applies to: All variants