Ferrara M, Kann BR. Urological injuries during colorectal surgery. Clin Colon Rectal Surg. 2019 May;32(3):196-203.
“A recent retrospective population-based study of patients in the United States undergoing colorectal surgery found the overall incidence of ureteral injury to be 0.28%. The incidence was found to be significantly higher in patients with stage 3 or 4 cancer, malnutrition, steroid use, and in operations done at teaching hospitals. Rectal cancer cases were found to have the highest rates of ureteral injuries (7.1/1,000), followed by Crohn’s disease and diverticular disease (2.9/1,000 each). In this review, laparoscopic surgery was associated with a lower incidence of ureteral injuries when compared with open (1.1 vs. 2.8/1,000, p < 0.001). Of the specific operations reviewed, abdominoperineal resection (APR) was found to have the highest rate of ureteral injury at 7.1/1,000 cases.” (Ferrara, 2019, p. 196)
Continue reading →
One discussion this week included ureteral injuries during colectomy.
Reference: Coakley KM, et al. Prophylactic ureteral catheters for colectomy: A National Surgical Quality Improvement Program-based analysis. Diseases of the Colon and Rectum. 2018 Jan;61(1):84-88. doi:10.1097/DCR.0000000000000976.
Summary: Despite improvement in technique and technology, using prophylactic ureteral catheters to avoid iatrogenic ureteral injury during colectomy remains controversial. The aim of this retrospective study was to evaluate outcomes and costs attributable to prophylactic ureteral catheters with colectomy. Conducted at a signle tertiary care center, the authors pulled clinical data, 2012-2014, from ACS NSQIP database.
A total of 51,125 patients were identified with a mean age of 60.9 ± 14.9 years and a BMI of 28.4 ± 6.7 k/m; 4.90% (n = 2486) of colectomies were performed with prophylactic catheters, and 333 ureteral injuries (0.65%) were identified.
- Prophylactic ureteral catheters were most commonly used for diverticular disease (42.2%; n = 1048), with injury occurring most often during colectomy for diverticular disease (36.0%; n = 120).
- Univariate analysis of outcomes demonstrated higher rates of ileus, wound infection, urinary tract infection, urinary tract infection as reason for readmission, superficial site infection, and 30-day readmission in patients with prophylactic ureteral catheter placement.
- On multivariate analysis, prophylactic ureteral catheter placement was associated with a lower rate of ureteral injury (OR = 0.45 (95% CI, 0.25-0.81)).
- Additional research is needed to delineate patient populations most likely to benefit from prophylactic ureteral stent placement.