Ureteral Injuries in Colorectal Surgery

Abstract

Iatrogenic ureteral injuries are rare complications in colorectal surgery; however, their incidence appears to be rising. Ureteral injuries are associated with higher mortality, morbidity, hospital charge, and length of stay, and their incidence can be predicted by several factors.

Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches

“…Our results were, however, adjusted for these factors. It has been hypothesized that operating on an irradiated pelvis is challenging along with the ureters adjacent to the dissection plane may lead to higher rates of iatrogenic ureteral injuries [17]. Nevertheless, we observed a higher rate of iatrogenic ureteral injuries in patients in whom a laparoscopic approach in rectal cancer surgery was used.…”

“…Consistent with our findings, a retrospective study from a single center of 5,729 patients with 14 ureteral injuries after colectomies performed for benign as well as malignant diseases showed a significant increase of iatrogenic ureteral injury occurring after laparoscopic surgery (n = 1,060) compared with open surgery (n = 4,669), 0.66 versus 0.15 %, P = 0.007 [16]. In contrast, in a recent nationwide retrospective study from the United States, use of the laparoscopic approach appeared to be a protective factor of iatrogenic ureteral injuries in colorectal surgery [17]. The study described 6,027 iatrogenic ureteral injuries among an estimated number of surgeries for benign and malignant diseases, but no information on whether laparoscopic surgery was performed to the same degree in benign and malignant conditions.…”

“…The study included 5,729 patients treated for benign as well as malignant colorectal diseases and found a significantly increased incidence of iatrogenic ureteral injury after laparoscopic versus open colectomy (0.66 vs 0.15 %, P = 0.007) [16]. In contrast, a recent nationwide study from the United States including 6,027 iatrogenic ureteral injuries has shown that laparoscopic approach was not associated with iatrogenic ureteral injury in colorectal surgery [17]. Patients were treated for benign as well as malignant colorectal diseases, and the indication for and frequency of the laparoscopic approach was not given.…”

“…In laparoscopic hysterectomy, an increased risk of iatrogenic urinary tract injuries has been observed in comparison with abdominal hysterectomy [14]. Iatrogenic ureteral injury is a serious, but rare complication associated with increased morbidity [15][16][17].…”

Procedural key steps in laparoscopic colorectal surgery, consensus through Delphi methodology

“…Our experts do not routinely perform this step. Ureter injuries are rare, but when they occur they are associated with significantly higher morbidity and mortality [11]. Risk of injury can be a legitimate reason not to open the retroperitoneum for the sole purpose of identifying the ureters, though in situations where this plane is opened for other reasons, good arguments can be made for exploration and identification.…”