Frequency of Lower Urinary Tract Injury after Gastrointestinal Surgery in the Nationwide Inpatient Sample Database

Abstract

Bladder and ureteral injury are serious iatrogenic complications during abdominal and pelvic surgery but are poorly investigated in the general surgery literature. The objective of this study was to examine rates, trends, and patient and surgical characteristics present in lower urinary tract injuries during gastrointestinal surgery using the Nationwide Inpatient Sample (NIS) database. The NIS database was queried from 2002 to 2010 for gastrointestinal surgery procedures including small/large bowel, rectal surgery, and procedures involving a combination of the two. These were crossreferenced with bladder and ureteral injury using International Classification of Diseases, 9th Revision, Clinical Modification codes. Multivariate regression analysis was used to calculate odds ratios for hypothesized risk factors. From 2002 to 2010, total average rates of bladder injury and ureteral injury were 0.15 and 0.06 per cent, respectively. Small/large bowel procedures had lower annual rates of ureteral (0.05 to 0.07%) and bladder (0.12 to 0.14%) injuries compared with ureteral (0.11 to 0.25%) and bladder (0.27 to 0.41%) injuries in rectal procedures. Presence of metastatic disease was associated with the greatest risk for bladder (odds ratio, 2.0; 95% confidence interval, 1.8 to 2.2) and ureteral (2.2; 1.9 to 2.5) injury in small/large bowel surgery, and for bladder (3.1; 2.5 to 3.9) and ureteral (4.0; 3.2 to 5.0) injury in combination procedures. Injury rates were significantly greater in open surgeries compared with laparoscopic procedures for both bladder injury (0.78 vs 0.26%, P < 0.0001) and ureteral injury (0.34 vs 0.06%, P < 0.0001). The incidence of genitourinary (GU) injury in gastrointestinal surgery is rare, less than 1.0 per cent, and is less than the incidence of GU injury reported in gynecologic surgery. This risk is increased by operations on the rectum and the presence of malignancy.

Robotic Surgery for Malignant Liver Disease: a Systematic Review of Oncological and Surgical Outcomes

“…The presence of 3 cases of urinary bladder injury is of the most relevant consideration [30,31]. There is, obviously, nothing reported of this complication in open liver surgery and only some series of laparoscopic pelvic surgery report data on bladder injuries but all of them during the surgical procedure [34,35]. Gynaecological procedures describe up to 8% of iatrogenic bladder injuries [34] whilst in general surgery procedures such as bowel resections (including rectal resection), it occurred between 0.12 and 0.41% [35].…”

“…There is, obviously, nothing reported of this complication in open liver surgery and only some series of laparoscopic pelvic surgery report data on bladder injuries but all of them during the surgical procedure [34,35]. Gynaecological procedures describe up to 8% of iatrogenic bladder injuries [34] whilst in general surgery procedures such as bowel resections (including rectal resection), it occurred between 0.12 and 0.41% [35]. Robotic liver surgery therefore might represent an increment in the rate of urinary bladder injuries and this data needs to be confirmed.…”

Urological Injuries during Colorectal Surgery

“…They also found metastatic disease to be significantly associated with elevated risk of ureteral injury. 10 Yet another retrospective review of a single institution's experience with colorectal surgery found an increased incidence of ureteral injury with laparoscopic versus open surgery (0.66 vs. 0.15%, p ¼ 0.007). 11 As can be seen from these studies, the relationship of surgical modality and ureteral injury is not clear.…”

Colo‐ureteric fistula: a rare complication in colorectal surgery

“…Ureteric injury is a recognized complication of abdominal surgery which involves mobilization of the large bowel . The incidence of colo‐ureteric fistulae after bowel surgery is extremely rare.…”