Retained Upper Genitourinary Gossypiboma Can Mimic Renal Neoplasms. A Review Of The Literature

Introduction: Retained iatrogenic foreign bodies (RIFB) are uncommon, preventable errors that carry serious professional and medico-legal consequences. Urological surgery is at increased risk of RIFB; due to the increasing complexity of endoscopic and minimally invasive procedures. Aim: We analysed all reported cases of RIFB in world literature and have compiled the first comprehensive review on the management of upper tract RIFB. Methods: A literature review using medical search engines was performed. Publications reporting non iatrogenic foreign bodies were excluded from the review. Retained foreign bodies are referred to by their name, except for retained surgical swabs which are referred to as gossypiboma. Data is presented as median (interquartile range). Results: Data was obtained and analysed on 40 cases. 37 cases (92.5%) were related to previous urological surgery; 14 (35%) percutaneous renal surgery, 11 (30%) open stone surgery (30%), 5 (13.5%) urinary diversion, 5 (13.5%) ureteroscopic surgery, 3 (8%) pyeloplasty surgery (8%). 7 (17.5%) patients with upper tract RIFB represented with symptomatic renal masses, 85% underwent a radical nephrectomy. Gossypiboma accounted for 85.8% of these renal lesions. Median interval between initial surgery and representation is 60 months (12 – 216). Of these patients 5 (71.4%) underwent a previous pyelolithotomy or nephrolithotomy. Conclusion: RIFB are preventable errors and measures should be put in place to reduce the incidence. When confronted with a patient who has renal mass and a history of previous surgery close to the area. One must consider the possibility of a gossypiboma.