Outcomes of Iatrogenic Genitourinary Injuries During Colorectal Surgery

Eswara, Jairam R.; Raup, Valary T.; Potretzke, Aaron M.; Hunt, Steven R.; Brandes, Steven B.

doi:10.1016/j.urology.2015.06.065

Cited by 39 publications

(31 citation statements)

References 14 publications

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“…Despite remarkable advances in image‐guided intervention, endoscopic approaches, and robotic surgical techniques, chronic organ leaks and fistulas secondary to inflammatory disease, trauma, or prior surgery remain difficult to treat. Examples include pancreatic, biliary, colorectal, bronchopleural, and genitourinary fistulas among many others. While a major focus has been on preventing such fistulas, once established, their treatment can be lengthy and complex, thereby adding to the financial healthcare burden.…”

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Supramolecular Metallo‐Bioadhesive for Minimally Invasive Use

et al. 2016

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Supramolecular Metallo‐Bioadhesive for Minimally Invasive Use

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“…In a retrospective study over a 16-year period, Basic et al [12] confirmed the severity of these injuries, even when appropriately treated, with 20% of major postrepair complications requiring prolonged urine derivation or complex reconstructions. Eswara et al [13] reported very similar results over a 10-year period.…”

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Iatrogenic ureteral injuries and their prevention in colorectal surgery: results from a nationwide survey

et al. 2019

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Aim Iatrogenic ureteral injury (IUI) occurs rarely during colorectal surgery but is associated with significant mortality, morbidity and medicolegal issues. Few cases are reported, and recommendations regarding prevention are lacking. The aim of this study is to describe the current state of practice regarding IUI and its prevention among general surgeons in Switzerland.78.4% of surgeons with more than 20 years of experience had encountered at least one IUI. Prophylactic ureteral stenting was considered useful in complex procedures by 93.5% of participants, and 56.9% had used stents at least once in the past 12 months. Noninvasive techniques for identifying ureters would be considered in regular daily practice by 54.5% of the participants.Conclusion Most general surgeons experience IUI. Ureter identification is widely integrated in colorectal procedures. Prophylactic stenting is widely used for difficult cases. Noninvasive methods to improve ureter identification are now needed.

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“…As up to 5%–15% of ureteral injuries occur during surgeries for the colon and rectum [ 5 ], prophylactic ureteral catheterization may be warranted in complicated abdominal surgeries or re-operations. However, in a recent large European retrospective analysis of 42,570 patients, there was only a 0.18% incidence of iatrogenic ureteral injury, with prior radiation and chemotherapy administration as major contributing factors [ 6 ]. In one study, the process of ureteral catheterization averages 11 minutes in both right and left laparoscopic hemi-colectomies [ 3 ].…”

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Ureteral catheters for colorectal surgery: Influence on operative times and complication outcomes: An observational study

2018

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PurposePlacement of pre-operative ureteral catheters for colorectal surgery can aid in the identification of ureteral injuries. This study investigates whether simultaneous ureteral catheterization with surgery skin preparation can minimize operating room times without increasing post-operative complications.Materials and MethodsPatients undergoing simultaneous colorectal surgery skin preparation and placement of pre-operative ureteral catheters (n=21) were compared to those who underwent these events sequentially (n=28). Operative time-points of anesthesia ready (AR), surgery procedure start (PS), dorsal lithotomy and catheter insertion (CI) times were compared to assess for differences between groups. Complications were compared between groups.ResultsThere were no differences in age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA), comorbidities, current procedure terminology (CPT) or International Classification of Diseases, 9th revision (ICD-9) codes between groups. Simultaneous catheterization saved 11.82 minutes of operative time between CI to PS (p=0.005, t-test). There was a significant difference in mean time between CI to PS (11.82 minutes, p=0.008) between simultaneous and sequential ureteral catheterization groups in a linear regression multivariate analysis controlling for age, BMI, CPT and ICD-9 codes. There were 4 complications in the simultaneous (19%) and 3 in the sequential group (11%) (p=0.68).ConclusionsUreteral catheterization and colorectal surgery skin preparation in a simultaneous fashion decreases the time between CI and PS without significant increase in complications. Mean time saved with simultaneous ureteral catheterization was 11.82 minutes per case. Simultaneous ureteral catheterization may be an option in colorectal surgery and may result in cost savings without additional complications.

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Outcomes of Iatrogenic Genitourinary Injuries During Colorectal Surgery

Cited by 39 publications

References 14 publications

Supramolecular Metallo‐Bioadhesive for Minimally Invasive Use

Supramolecular Metallo‐Bioadhesive for Minimally Invasive Use

Iatrogenic ureteral injuries and their prevention in colorectal surgery: results from a nationwide survey

Ureteral catheters for colorectal surgery: Influence on operative times and complication outcomes: An observational study

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