Does prophylactic ureteric stenting at the time of colorectal surgery reduce the risk of ureteric injury? A systematic review and meta‐analysis

Hird, Amanda; Nica, Andra; Coburn, Natalie; Kulkarni, Girish S.; Nam, Robert K.; Gien, Lilian T.

doi:10.1111/codi.15498

Cited by 20 publications

(24 citation statements)

References 20 publications

(55 reference statements)

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“…Other authors also recommend the use of a catheter with light at the tip or the use of fluorescence devices with the intravenous injection of methylene blue for better identification of the ureters intraoperatively (BERALDO et al, 2013;SPEICHER et al, 2014). The use of a ureteral catheter during colorectal surgery, especially in laparoscopic access, where palpation of the ureters is not possible, can help in their identification (HIRD et al, 2021;MEROLA et al, 2018;SMITH & KACHNIC, 2017). Despite the ease offered, the procedure was associated with increased surgical time and expenses, as well as adverse events such as the ureteral obstruction and urinary tract infection (BURKS & SANTUCCI, 2014;ELAWDY et al, 2021;HIRD et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

Ureteral Injuries in Coloretal Surgery - Bibliographic Review

Lima¹,

Ayrizono²,

Lima³

2022

JHS

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Introduction: Iatrogenic ureteral injuries (UII) are surgical complications associated with high morbidity, with an incidence ranging from 0.3% to 1.5%, and most commonly observed in gynecological and colorectal surgeries. Objective: To evaluate the factors that influenced LUI in colorectal surgeries and their history of diagnosis and treatment performed. Method: Bibliographic review carried out on the PubMed platform, 29 articles were selected, published between 2005 and 2021. Results: LUI were more frequently observed in the distal ureter and in women. Among the risk factors, the anatomical ones stand out (adherence of the ureter to the peritoneum, similarity with the ovarian ligaments and uterine artery and its proximity to important pelvic structures), anatomopathological (congenital anomalies, pelvic tumors, colorectal cancer, previous surgery and irradiation). pelvic, endometriosis, inflammatory/infectious processes and inflammatory bowel disease) and technical (bleeding in the operative field, advanced tumor, malnutrition and surgeons on a learning curve). As protective factors, right and transverse colon colectomy and, in some studies, videolaparoscopic surgery were identified, the latter not being a consensus. The indication of prophylactic ureteral catheter is not clear in the literature. They are usually indicated in reoperations, large pelvic tumors, laparoscopic surgeries, previous radiotherapy, diverticulitis, occurrence of fistulas, Crohn's disease and obesity. In the immediate suspicion of LUI, careful intraoperative visual inspection and use of retrograde or anterograde ureteropyelography were reported. In late diagnosis, computed tomography with intravenous contrast was the most used exam. In the treatment of LUI, the type of surgical correction depended on the severity and location of the lesion. Conclusion: Colorectal cancer, neoadjuvant radiotherapy and chemotherapy, pelvic recurrence, malnutrition and surgery performed in teaching hospitals were important risk factors for LUI. The use of an adequate and judicious surgical technique and the early diagnosis of ureteral lesions were more decisive factors than the surgical approach used.

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Section: Resultsmentioning

confidence: 99%

Ureteral Injuries in Coloretal Surgery - Bibliographic Review

Lima¹,

Ayrizono²,

Lima³

2022

JHS

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“…Importantly, prophylactic ureteric stenting was not associated with increased patient morbidity with respect to the studied outcomes. Operating time was significantly longer in the intervention group, which may have significant cost implications [10].…”

Section: Discussionmentioning

confidence: 99%

The use of JJ stent in the management of deep pelvic malignancies, does it prevent the ureteric injury?

2021

SECI Oncology Journal

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Deep pelvic malignancies are characterized by compression or infiltration of the lower ureters which causes obstruction of one or both kidneys that causes rising of the renal functions and deterioration of the general condition. Compression or invasion of the ureters makes the surgery more difficult and ureteric identification is not easy, subsequently, ureteric injury could happen easily and the repair is more difficult that may cause serious complications such as urine leakage or postoperative ureteric strictures and kidney obstruction.Most cases are incidentally discovered with renal obstruction unilateral or even bilateral due to compression by the tumor, during preoperative investigations1.About 30% of cases presented by ureterohydronephrosis secondary to ureteral compression or invasion that may cause loss of the affected kidney. [1] Compression or invasion of the ureters by tumors makes identification is very difficult, moreover ureteric injury occurs easily that makes the repair is very difficult due to distorted anatomy and friable tissues.Sometimes, long segment of the ureter could be lost, that requires boari flap with or without psoas hitch for repair. [2] Moreover, most of the ureteral injuries are discovered postoperatively and, in more than 2/3 of cases, open surgery to repair the injury is the favorite choice which causes more morbidity. [2] [3] Ureteral identification interaoperativly might prevent most of the injuries or at least facilitate the repair if occurred. Preoperative insertion of a ureteric stent could help in identification of the ureters and prevent iatrogenic injuries during dissection.We report here our experience in those patients undergoing laparotomy for deep pelvic malignancies such as cervical, ovarian or rectal cancers. Preoperative insertion of ureteric stents such as JJ tube or ureteric catheter is performed endoscopically by use of Cystoscope. This is done by a urologist before surgery in a separate session or immediate preoperatively in the same session.The aim of this study was to demonstrate the benefit of the ureteric stent in identification of the ureters, prevention of ureteric injuries during surgery for deep

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“… 23 Ureteral catheterization did not lead to a decrease of iatrogenic UI as expected according to some studies. 16 , 24 Nevertheless, the procedure of catheterization itself could also cause ureteric perforation, urinal bleeding, etc. 17 , 25 Besides, postoperative hematuria, urinary tract infection, prolonged operative time, and hospital stay were commonly reported associating with catheterization.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Ureteral Catheter Placement Appears to Reduce Intraoperative Ureteric Injury During Resection of Primary Retroperitoneal Liposarcoma

Chen

Cananzi

et al. 2022

Technol Cancer Res Treat

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Background: Prophylactic ureteral catheters placement (PUCP) was advocated as an effective strategy for decreasing ureteral morbidities in colorectal surgeries. However, whether it should be routinely used prior to primary retroperitoneal liposarcoma (PRLS) surgeries remains unknown. Methods: It was a retrospective study, conducted at a tertiary sarcoma center. Medical records of patients with PRLS undergoing surgeries from January 2015 through December 2018 were reviewed. Primary endpoint was the rate of ureteral morbidities during and after retroperitoneal liposarcoma resection procedures. Univariate and multivariate analyses determined risk factors associated with ureteral injury (UI) in patients undergoing surgeries. Results: A total of 55 patients of PRLS were included. Fourteen (25.5%) patients underwent PUCP, with 1 UI (7.1%) identified. In 41 patients with no PUCP, 15 (36.6%) exhibited UIs during and post surgeries. There were significant improvements of UIs in group PUCP, compared with patients without PUCP ( P < .05). Resection surgeries combined with colectomy and tumor-ureter relationship were 2 risk factors significantly associated to UIs ( P < .01). Conclusions: PUCP might be an effective way of preventing UIs in patients with PRLS. It could be suggested especially in patients with ureter encased by tumor or anticipated colectomy during the surgical process.

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Does prophylactic ureteric stenting at the time of colorectal surgery reduce the risk of ureteric injury? A systematic review and meta‐analysis

Cited by 20 publications

References 20 publications

Ureteral Injuries in Coloretal Surgery - Bibliographic Review

Ureteral Injuries in Coloretal Surgery - Bibliographic Review

The use of JJ stent in the management of deep pelvic malignancies, does it prevent the ureteric injury?

Prophylactic Ureteral Catheter Placement Appears to Reduce Intraoperative Ureteric Injury During Resection of Primary Retroperitoneal Liposarcoma

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