Ureteral injuries in colorectal surgery and the impact of laparoscopic and robotic-assisted approaches

Mayo, John; Brazer, Miriam L.; Bogenberger, Kenneth; Tavares, Kelli; Conrad, Robert Joseph; Lustik, Michael B.; Gillern, Suzanne; Park, Chan W.; Richards, Carly R.

doi:10.1007/s00464-020-07714-1

Cited by 14 publications

(10 citation statements)

References 34 publications

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“…colonic ischaemia). Our study did not analyse the impact of laparoscopy on IUI, unlike others [4,6,19]. report an increase in operating time, with new-onset urinary complications without a decrease in IUI rates [21].…”

Section: Discussionmentioning

confidence: 74%

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Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study

et al. 2023

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Aim The long‐term urological sequelae after iatrogenic ureteral injury (IUI) during colorectal surgery are not clearly known. The aims of this work were to report the incidence of IUI and to analyse the long‐term consequences of urological late complications and their impact on oncological results of IUI occurring during colorectal surgery through a French multicentric experience (GRECCAR group). Method All the patients who presented with IUI during colorectal surgery between 2010 and 2019 were retrospectively included. Patients with ureteral involvement needing en bloc resection, delayed ureteral stricture or noncolorectal surgery were not considered. Results A total of 202 patients (93 men, mean age 63 ± 14 years) were identified in 29 centres, corresponding to 0.32% of colorectal surgeries (n = 63 562). Index colorectal surgery was mainly oncological (n = 130, 64%). IUI was diagnosed postoperatively in 112 patients (55%) after a mean delay of 11 ± 9 days. Intraoperative diagnosis of IUI was significantly associated with shorter length of stay (21 ± 22 days vs. 34 ± 22 days, p < 0.0001), lower rates of postoperative hydronephrosis (2% vs. 10%, p = 0.04), anastomotic complication (7% vs. 22.5%, p = 0.002) and thromboembolic event (0% vs. 6%, p = 0.02) than postoperative diagnosis of IUI. Delayed chemotherapy because of IUI was reported in 27% of patients. At the end of the follow‐up [3 ± 2.6 years (1 month–13 years)], 72 patients presented with urological sequalae (36%). Six patients (3%) required a nephrectomy. Conclusion IUI during colorectal surgery has few consequences for the patients if recognized early. Long‐term urological sequelae can occur in a third of patients. IUI may affect oncological outcomes in colorectal surgery by delaying adjuvant chemotherapy, especially when the ureteral injury is not diagnosed peroperatively.

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Section: Discussionmentioning

confidence: 74%

“…colonic ischaemia). Our study did not analyse the impact of laparoscopy on IUI, unlike others [4, 6, 19].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study

et al. 2023

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“…et al, 2014). Surgeries related to benign polyps, diverticular disease and IBD are also related, but to a lesser extent (HALABI et al, 2014;MAYO et al, 2021;SPEICHER et al, 2014).…”

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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“…1,2 Some previous studies have shown that colorectal surgery accounts for 1%-10% of iatrogenic ureteral injuries, but the frequency has recently decreased to <1%. [3][4][5] According to the EAU guidelines, for postoperative ureteral injuries, ureteral stenting or nephrostomy should be implanted first, followed by ureteral reconstruction if conservative treatment is ineffective. 6 According to studies, most iatrogenic ureteral injuries improved spontaneously after ureteral stenting or nephrostomy.…”

Section: Discussionmentioning

confidence: 99%

“…The most common cause of iatrogenic ureteral injury is gynecologic surgery (55%–65%), followed by digestive surgery (15%–25%) and urological surgery (11%–25%) 1,2 . Some previous studies have shown that colorectal surgery accounts for 1%–10% of iatrogenic ureteral injuries, but the frequency has recently decreased to <1% 3–5 …”

Section: Discussionmentioning

confidence: 99%

A case of one‐stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury associated with infected urinoma

Takahashi,

Maruno,

Hazama

et al. 2023

IJU Case Reports

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IntroductionIatrogenic ureteral injury is a rare but often encountered complication of abdominal and gynecological surgery. This is a case of iatrogenic ureteral injury with infected urinoma treated with one‐stage laparoscopic drainage and ureterocystoneostomy.Case presentationAn 80‐year‐old man with rectal cancer had robot‐assisted low anterior rectum resection and left lateral lymph node dissection after colostomy and preoperative chemoradiotherapy. On the 14th postoperative day, he had a fever, and a noncontrast‐enhanced computed tomography scan revealed a low‐density polycystic area in the left pelvic cavity. Retrograde pyelography revealed contrast medium leaking from the left lower ureter, preventing ureteral stent placement. We identified it as a delayed ureteral injury with infected urinoma and performed laparoscopic one‐stage drainage and ureterocystoneostomy.ConclusionThis study reported a case of one‐stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury with infected urinoma.

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Ureteral injuries in colorectal surgery and the impact of laparoscopic and robotic-assisted approaches

Cited by 14 publications

References 34 publications

Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study

Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study

Ureteral Injuries in Coloretal Surgery - Bibliographic Review

A case of one‐stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury associated with infected urinoma

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