Trends and benefits of prophylactic ureter catheters in the era of minimally invasive surgery

Abstract

Background: The recent spike in ureter injury (UI) amidst the rise of minimally invasive surgery (MIS) has focused attention on the propriety of prophylactic ureter catheters (PUCs) for abdominopelvic operations.

Methods: A retrospective review of PUCs for rectal cancer resection following neoadjuvant therapy, combined with a comprehensive literature review.

Results: There were zero UI in the current study. Literature review revealed a nationwide spike in PUCs in the last 30 years, dependent on operation: 1) colorectal resection-increased from 1.1% to 4.4%, 2) sigmoid colectomy for diverticulitis-increased from 6.7% to 16.3%. This 2-4 fold increase parallels the rise of MIS: 15 of the 20 latest studies (75%) either combined open operations and MIS (4 studies) or focused solely on MIS (11 studies). Medial-to-lateral dissection identified as a UI risk factor. Only 20-30% of UI identified intraoperatively.

Conclusions: Intraoperative UI is missed in 70-80% of cases. The prevention, identification, ease of ureter repair, and net decrease in operative time support the use of PUCs. Medial-to-lateral dissection is identified as a potential contributing factor to UI.