Prophylactic ureteral catheterization in the intraoperative diagnosis of iatrogenic ureteral injury

Dumont, Sander; Chys, Brecht; Meuleman, Christel; Verbeke, Geert; Joniau, Steven; Aa, Frank Van der

doi:10.1080/00015458.2020.1753148

Cited by 12 publications

(12 citation statements)

References 10 publications

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“…On the other hand, prophylactic ureteric stenting has been shown to decrease the rate of severe injuries such as a complete transection during gynaecological surgery [12]. Furthermore, prophylactic ureteric stenting is also thought to facilitate intraoperative detection of ureteric injuries during abdominal/pelvic surgery [12,34,70]. Dumont et al.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta‐analysis

et al. 2022

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To assess the incidence of ureteric injuries, clinical value of prophylactic ureteric stenting and impact of intra-or postoperative detection of ureteric injuries in patients treated with gynaecological or colorectal surgery. MethodsMultiple databases were searched for articles published before September 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Studies were deemed eligible if they evaluated the differences in the rate of ureteric injuries between laparoscopic and open surgery, prophylactic ureteric stenting or not, and those of final treatment success between intra-and postoperative detection in patients who underwent gynaecological or colorectal surgery. ResultsOverall, 46 studies were eligible for this meta-analysis. Compared to open surgery, laparoscopic hysterectomy was associated with a higher incidence of ureteric injuries (pooled odds ratio [OR] 2.12, 95% confidence interval [CI] 1.71-2.62), but there was no statistically significant difference in colectomy (pooled OR 0.89, 95% CI 0.77-1.03). Prophylactic ureteric stenting was associated with a lower incidence of ureteric injuries during gynaecological surgery (pooled OR 0.61, 95% CI 0.39-0.96). The number needed to perform ureteric stenting to prevent one ureteric injury was 224 in gynaecological surgery. On the other hand, prophylactic ureteric stenting did not reduce the risk of ureteric injuries during colorectal surgery. Intraoperative detection of a ureteric injury was associated with a lower rate of complication management failure compared to postoperative detection (pooled OR 0.22, 95% CI 0.12-0.41). ConclusionsLaparoscopic hysterectomy seems to be associated with a higher rate of ureteric injuries compared to an open approach. Prophylactic ureteric stenting seems to reduce this risk during gynaecological surgery. Intraoperative detection of a ureteric injury during abdominal/pelvic surgery improves outcomes, suggesting the need for awareness and proactive problem identification. Further well-designed studies assessing the candidates who are more likely to benefit from prophylactic ureteric stenting including cost analysis are needed.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta‐analysis

et al. 2022

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“…Regarding prophylactic stents, randomised controlled trials of their use in gynaecological procedures have given mixed results regarding reduced rates of ureteric injury [ 118 , 119 ]. However, ureteric stent use may reduce diagnostic delay and post-operative morbidity [ 120 ].…”

Section: Discussionmentioning

confidence: 99%

Systematic review of urological injury during caesarean section and hysterectomy

et al. 2022

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Introduction and hypothesis We aim to review iatrogenic bladder and ureteric injuries sustained during caesarean section and hysterectomy. Methods A search of Cochrane, Embase, Medline and grey literature was performed using methods pre-published on PROSPERO. Eligible studies described iatrogenic bladder or ureter injury rates during caesarean section or hysterectomy. The 15 largest studies were included for each procedure sub-type and meta-analyses performed. The primary outcome was injury incidence. Secondary outcomes were risk factors and preventative measures. Results Ninety-six eligible studies were identified, representing 1,741,894 women. Amongst women undergoing caesarean section, weighted pooled rates of bladder or ureteric injury per 100,000 procedures were 267 or 9 events respectively. Injury rates during hysterectomy varied by approach and pathological condition. Weighted pooled mean rates for bladder injury were 212–997 events per 100,000 procedures for all approaches (open, vaginal, laparoscopic, laparoscopically assisted vaginal and robot assisted) and all pathological conditions (benign, malignant, any), except for open peripartum hysterectomy (6,279 events) and laparoscopic hysterectomy for malignancy (1,553 events). Similarly, weighted pooled mean rates for ureteric injury were 9–577 events per 100,000 procedures for all hysterectomy approaches and pathologies, except for open peripartum hysterectomy (666 events) and laparoscopic hysterectomy for malignancy (814 events). Surgeon inexperience was the prime risk factor for injury, and improved anatomical knowledge the leading preventative strategy. Conclusions Caesarean section and most types of hysterectomy carry low rates of urological injury. Obstetricians and gynaecologists should counsel the patient for her individual risk of injury, prospectively establish risk factors and implement preventative strategies.

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“…Although prophylactic stenting has been proposed, its use has not consistently been linked to increased detection of IUI or reduced complications. 18,19 Furthermore, the utility of cystoscopy to identify IUI intraoperatively is unproved due to its low specificity for detecting IUI and the rarity of IUIs in general. 20–22 In our series, we identified previous radiation as a risk factor for delayed recognition of IUI.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Introduction: Iatrogenic ureteral injuries (IUIs) are rare but can lead to significant consequences if unrecognized at the time of injury. We compare the impact of immediate vs delayed recognition of IUIs on clinical, cost and health care utilization outcomes. Methods:We conducted a population-based retrospective cohort study on patients who had a diagnosis of an IUI between 2003 and 2018. The primary independent variable was the time of diagnosis of IUI. The primary clinical outcomes evaluated included renal impairment and a composite outcome: hydronephrosis or stricture. Secondary outcomes included total direct health care costs and health care utilization. Results:We identified 1,193 patients who experienced an IUI, 25.2% of whom had a delay in recognition. Delayed recognition of IUI was associated with hydronephrosis or stricture within 1 year following treatment of IUI (OR 2.27, 95% CI 1.69e3.04, p <0.0001) and renal impairment within 2 years following treatment of IUI (OR 2.69, 95% CI 1.84e3.94, p <0.0001) compared to immediate diagnosis. Total health care costs (incident rate ratio [IRR] 2.06, 95% CI 1.89e2.24, p <0.0001), emergency department visits (IRR 2.07, 95% CI 1.77e2.43, p <0.0001), hospitalizations (IRR 1.62, 95% CI 1.48e1.78, p <0.0001) and outpatient urology visits (IRR 1.45, 95% CI 1.31e1.60, p <0.0001) were significantly higher in those with delayed recognition compared to immediate. Previous radiation was significantly associated with delayed recognition of IUI (OR 0.64, 95% CI 0.42e0.97, p¼0.04).Conclusions: Delayed recognition of IUI is associated with significant clinical, cost and health care utilization consequences.

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Prophylactic ureteral catheterization in the intraoperative diagnosis of iatrogenic ureteral injury

Cited by 12 publications

References 10 publications

Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta‐analysis

Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta‐analysis

Systematic review of urological injury during caesarean section and hysterectomy

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

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