Prophylactic Ureteral Catheterization for Preventing Ureteral Injury in Colorectal Cancer Surgery

Abstract

Background/Objective: Iatrogenic ureteral injury is a rare but serious complication of colorectal cancer surgery. Although prophylactic ureteral catheterization (PUC) is used to facilitate intraoperative ureter identification and reduce the risk of ureteral injury, its efficacy is debated. We aimed to evaluate the clinical utility and outcomes of PUC in colorectal cancer surgery. Methods: This retrospective study included 42 patients who underwent PUC before colorectal cancer surgery at the Tohoku University Hospital between February 2010 and September 2024. Preoperative ureteral stents were inserted via cystoscopy under general anesthesia. Patient demographics, surgical techniques, indications for catheterization, and post-procedural complications were reviewed. Results: PUC was most frequently performed in patients with left-sided colorectal cancer (61.9%) and local recurrence of rectal cancer (31%). Ureteral catheterization was indicated in patients with a history of pelvic surgery (47.6%) or tumor proximity to the ureter (26.2%). Open surgery was performed in 90.5% of the cases, whereas robotic surgery with fluorescent ureteral catheters was used in selected patients. No intraoperative ureteral injury was observed in the stent group. Catheter-related complications, including hematuria (14.3%) and urinary tract infections (9.5%), were minor and resolved before discharge. Conclusions: PUC may be beneficial in patients with a history of pelvic surgery or local recurrence of rectal cancer, in whom the risk of ureteral injury is inherently higher.

Keywords: colorectal cancer; iatrogenic ureteral injury; prophylactic ureteral catheterization.

Figure 1

Flowchart of patient selection in this study. CRC: colorectal cancer, LR: local recurrence.

Figure 2

Identification of the ureter with the help of a fluorescent ureteral stent (a) in a rectal cancer patient with a body mass index of 44 kg/m² and (b) in a patient with lateral lymph node metastasis.