Morbidity and predictors of delayed recognition of iatrogenic ureteric injuries

Abstract

Introduction: Although intraoperative iatrogenic ureteric injuries (IUI) are rare, significant consequences can occur if they are unrecognized at the time. The focus of our study is to characterize the associated morbidity and identify predictors of delayed recognition of IUI.
 Methods: Sunnybrook Health Sciences Centre Research Ethics Board approved the study. Patients with a diagnosis of IUI between 2002 and 2020 were identified through an institutional electronic medical record system. Data pertaining to the demographic characteristics, diagnosis, and management of IUI and overall outcomes were collected retrospectively.
 Results: Of the 103 patients identified, 83% were female, 52% had previous abdominal surgery, and 18% had previous radiation. The median age was 67 (21–88) years. Twenty percent were not recognized at the time of surgery. Although delayed recognition was not a significant predictor for poor outcome after subsequent repair (i.e., hydronephrosis, ureteric stricture/obstruction), it was associated with substantial morbidity to the patient (i.e., additional procedures) and increased cost to the healthcare system (i.e., longer hospital stay, readmission to hospital). Patients who underwent laparoscopic surgery had an 11 times more likely chance of having an unrecognized IUI as compared to those who underwent open surgery (odds ratio 11.515, p=0.0001).
 Conclusions: Delayed recognition of IUI may be associated with considerable adverse effects. In this retrospective case series, we identified laparoscopic surgery as a significant predictor for delayed recognition of IUI. This information underscores the need for future studies to facilitate intraoperative identification of ureteric injuries, particularly during laparoscopic procedures.

Impact of Delayed Recognition of Iatrogenic Ureteral Injury in a Retrospective Population-Based Study

“…Similarly, we found the incidence of delayed recognition of IUI in our institutional series of 103 patients to be 20%. 4 Herein, we found that patients who had a delayed recognition of IUI were approximately 2 times more likely to develop hydronephrosis or stricture and 3 times more likely to develop renal impairment than those with immediately diagnosed IUI. Total costs were approximately 2 times higher in those with a delayed diagnosis of IUI.…”

“…To validate this definition of IUI, we compared the number of patients identified using this approach at our institution to those identified in our electronic medical records system and noted an agreement of 103 patients. 4…”

“…2,3 In our institutional series of 103 patients with IUI, we observed significant patient morbidity with the delayed recognition of IUI. 4 However, due to the limitations of our single institution review, we could not examine the overall impact of delayed recognition of IUI on the patient and the health care system. Furthermore, the few single-institution case series in the literature investigating the clinical consequences of IUI 5–9 do not provide longitudinal followup across the entire health care system to assess for all outcomes.…”

Double-J Stent Misplacement in the Inferior Vena Cava and Right Atrium: A Urovascular Nightmare

“…Patients presenting postoperatively may experience signs and symptoms of renal obstruction, such as flank pain, a febrile postoperative course, ileus, a urine leak, and a rise in serum creatinine [20] . Delayed UI detection is associated with significantly higher rates of 90-d readmission, sepsis, urinary fistula, acute renal injury, and death [19] , [21] . Furthermore, postoperative UI detection typically requires temporary urinary diversion and multiple procedures or operations for definitive management, which has a considerable negative impact on patient mental health, patient-partner relationships, employment, litigation, and health care costs [17] , [20] , [21] .…”

Near‐infrared ray catheter and indocyanine green via nephrostomy in delayed robotic reconstruction of injured ureter: A case report

“…As the number of laparoscopic surgeries increases, a higher proportion of iatrogenic ureteral injuries postoperatively are found 1 . More than half of these injuries are postoperatively recognized in response to symptoms such as abdominal pain, fever, or nausea 2 . Although immediate surgical repair of iatrogenic ureteral injuries is usually successful, delayed surgical repair can be challenging and may require the expertise of a urologist 1 .…”