Ureteric Ischaemia Following Major Colorectal Resection

Abstract

An ischaemic injury of the ureter following major colorectal surgery is reported. The aetiology and incidence of this unusual complication is reviewed. Surgical techniques for prevention of such an injury are discussed.

Laser Doppler Flowmetric Determination of Ureteral Blood Flow after Ureteral Access Sheath Placement

“…Yet situations have been described that involve some type of insult to the ureteral microvasculature. [21][22][23][24][25] Thus, a patient with a history of ureteral or retroperitoneal surgery or radiation to the retroperitoneum may be predisposed to ureteral ischemia and could suffer long-term complications from access sheath-assisted ureteroscopy. Such individuals may benefit from interventions that decrease the potential risk of access sheath use, such as preoperative stent placement, use of a smaller access sheath, and shorter operative time.…”

Role of prophylactic ureteric stents in colorectal surgery

“…In the remaining three patients, the injuries were recognized postoperatively: one underwent late repair and eventually died from peritonitis, and the other two patients developed acute renal failure (one required nephrectomy and the other died from recurrent carcinoma). Late injuries present as flank pain, fever, urinary fistulas or intrabdominal collections, and are associated with increased morbidity and cost (5,14). The stents facilitate the intraoperative identification of an injury and aid in the repair should an injury occur (1,3,9).…”

Ureteric injuries during colorectal surgery: strategies for prevention

“…In one of our patients in whom the ureter was dissected and identified along its entire length a process of devascularization and subsequent necrosis of a segment was the likely mechanism of damage. Previous aortic surgery can compromise the blood supply of the ureter and may render it ischaemic with subsequent manipulation [ 23]. Teneriello et al .…”

“…In one of our patients in whom the ureter was dissected and identi®ed along its entire length a process of devascularization and subsequent necrosis of a segment was the likely mechanism of damage. Previous aortic surgery can compromise the blood supply of the ureter and may render it ischaemic with subsequent manipulation [23]. Teneriello et al recommend gentle handling of the ureter with incision of the posterior peritoneum lateral to the proximal ureter and medial to the distal ureter to avoid disrupting its blood supply [24].…”