Preventing iatrogenic ureteral injury in colorectal surgery: a comprehensive and systematic review of the last 2 decades of literature and future perspectives

Brollo, Pier Paolo; Puggioni, Alessandro; Tumminelli, Francesco; Colangelo, Antonio; Biddau, Carlo; Cherchi, Vittorio; Bresàdola, Vittorio

doi:10.1007/s00595-022-02639-9

Cited by 13 publications

(10 citation statements)

References 51 publications

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“…To minimize the risk of IUTI, surgeons need a technology that enhances intraoperative visualization of the ureters, preventing injuries, and facilitating prompt detection and subsequent repair in case of an injury. During the last decades, prophylactic ureteral stents, including lighted ureteral stents and near-infrared fluorescent ureteral catheters, and fluorescent dyes such as indocyanine green and methylene blue, have emerged as potentially useful and promising techniques for the prevention of IUTI [ 3 , 53 , 54 ].…”

Section: Key Questionsmentioning

confidence: 99%

“…Different methods of injecting ICG into the ureters have been described, but in general, the procedure involves cystoscopy, ureteral stenting, and injection of ICG into the ureteral orifice before or during surgery. The dosage of intraureteral ICG varies from 5.0 to 12.5 mg [ 3 ]. ICG reversibly binds to and stains the proteins of the ureteral epithelium, and the ureter is identified by the emission of a fluorescent signal when ICG is excited using near-infrared laser fluorescence technology [ 81 ].…”

Section: Key Questionsmentioning

confidence: 99%

“…The reported incidence of iatrogenic ureteral injury during elective abdominal surgery ranges between 0 and 1.5% [ 3 – 6 ]; this increases in emergency settings. Local inflammation caused by diverticulitis or complicated inflammatory bowel disease, fibrosis resulting from prior abdominopelvic surgeries or radiotherapy, and locally advanced neoplastic disease can be associated to anatomical distortions and lead to more complex surgical dissection.…”

Section: Introductionmentioning

confidence: 99%

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2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

de’Angelis,

Schena,

Marchegiani

et al. 2023

World J Emerg Surg

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Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.

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Section: Key Questionsmentioning

confidence: 99%

Section: Key Questionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

de’Angelis,

Schena,

Marchegiani

et al. 2023

World J Emerg Surg

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“…Intraoperative ureteral identification and diagnosis are required in order to prevent IUIs and to detect renal injuries early. Ureteral stent placement has previously been employed; however, this technique results in a longer operating time, a higher risk of acute kidney injury (AKI), and urinary tract complications, as well as higher costs [5][6][7]. The ureters were intraoperatively identified based on the fluorescence of methylene blue (MB), a diagnostic agent approved by the Food and Drug Administration, present in urine after the intravenous administration of MB [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Utilization of Near-Infrared Fluorescent Contrast Agent ASP5354 for In Vivo Ureteral Identification in Renal Diseases Using Rat Models of Gentamicin-Induced Acute Kidney Injury

Teranishi

2023

Diagnostics

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ASP5354 was recently developed as a near-infrared fluorescence (NIRF) contrast agent for intraoperative ureteral identification, and its use has been evaluated in healthy animals. However, the utilization of ASP5354 for ureteral identification has not been evaluated in animals with renal injury. In this study, we assessed the application of ASP5354 for ureteral imaging using rat models of gentamicin-induced mild, moderate, and severe acute kidney injury (AKI), using a clinically available NIRF detection system. NIRF was detected in the abdominal cavity and ureters after laparotomy, and the efficiency of ASP5354 was evaluated based on the NIRF signal intensity over 60 min. After the intravenous injection of ASP5354 into rats with mild or moderate AKI, the ureters were clearly imaged at a high ratio of NIRF intensity in the ureter to that in the tissues around the ureter. Six days after intravenous injection, the use of ASP5354 in rats with moderate AKI did not affect the biochemical kidney functions or histopathological conditions of the kidney tissues, as compared to those with no injection of ASP5354. In rats with severe AKI, ureteral imaging was not effective due to the relatively strong NIRF expression in the tissues around the ureters. These data indicate that ASP5354 holds potential as a contrast agent for intraoperative ureteral identification in patients with limited renal injury.

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“…Mean operative times for ureteric stent/ICG were only 9.5–20 min longer 13,14 . A recent systematic review of studies over the last two decades demonstrated lower rates of both iatrogenic ureteral injury (IUI) and urinary tract morbidity with ICG compared to ureteric stents 15 . Namely, mean rates of IUI, acute kidney injury and urinary tract infections were reported as 0.3%, 3.6% and 1.1% respectively.…”

mentioning

confidence: 99%

Use of ureteric catheters and indocyanine green in complex pelvic surgery: a must or a luxury in 2023?

Othman

Pham

Mohan

et al. 2023

ANZ Journal of Surgery

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Preventing iatrogenic ureteral injury in colorectal surgery: a comprehensive and systematic review of the last 2 decades of literature and future perspectives

Cited by 13 publications

References 51 publications

2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

Evaluation of the Utilization of Near-Infrared Fluorescent Contrast Agent ASP5354 for In Vivo Ureteral Identification in Renal Diseases Using Rat Models of Gentamicin-Induced Acute Kidney Injury

Use of ureteric catheters and indocyanine green in complex pelvic surgery: a must or a luxury in 2023?

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