Literature review conducted and presented by Dr. Clara Farley
EUA guidelines on iatrogenic bladder trauma:
- Repair in two layers with absorbable sutures
- Postop bladder drainage is required for 7-14 days
- Cystoscopy is advised
Bacteriuria in patients with indwelling catheters occurs at a rate of approx. 3-10% per day of catheterization:
- Of those with bacteriuria, approx. 10-25% develop UTI (GU or systemic symptoms)
- 4% of less develop catheter related bacteremia
Association between the rate of UTI and duration of catheterization:
- 15% at 3 days
- 68% at 8 days
Andersen P, et al. Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches. Surg Endosc. 2015 Jun;29(6): 1406-12.
Full-text for Emory users.
Results: A total of 18,474 patients had a resection for colorectal cancer. Eighty-two ureteral injuries were related to colorectal surgery. The rate of ureteral injuries in the entire cohort was 0.44 %, with 37 (0.59 %) injuries in the laparoscopic group (n = 6,291) and 45 (0.37 %) injuries in the open group (n = 12,183), (P = 0.03). No difference in ureteral injury was found in relation to surgical approach in colon cancer patients. In rectum cancer patients (n = 5,959), the laparoscopic approach was used in 1,899 patients, and 19 (1.00 %) had ureteral injuries, whereas 17 (0.42 %) of 4,060 patients who underwent an open resection had a ureteral injury. In multivariate analysis adjusted for age, gender, ASA score, BMI, tumor stage, preoperative chemo-radiation, calendar year, and specialty of the surgeon, the laparoscopic approach was associated with an increased risk of ureteral injury, OR = 2.67; 95 % CI 1.26-5.65.
Conclusion: In this nationwide study laparoscopic surgery for rectal cancer with curative intent was associated with a significantly increased risk of iatrogenic ureteral injury compared to open surgery.
One discussion this week involved the use of prophylactic flomax in preventing postoperatuve urinary retention (POUR).
Reference: Ghuman A, et al. Prophylactic use of alpha-1 adrenergic blocking agents for prevention of postoperative urinary retention: A review & meta-analysis of randomized clinical trials. American Journal of Surgery. 2018 May;215(5):973-979. doi: 10.1016/j.amjsurg.2018.01.015. Epub 2018 Feb 3.
Summary: With an increase in outpatient and fast-track surgical procedures, urethral catheterization is used less commonly thus increasing the likelihood of POUR. Urethral catheterization, a mainstay of initial management for patients with POUR, can
be associated with prolonged length of hospital stay and complications, such as urinary tract infections that may increase cost of care.