Clin Colon Rectal Surg 2019; 32(03): 196-203
DOI: 10.1055/s-0038-1677026
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Urological Injuries during Colorectal Surgery

Marco Ferrara
1   Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
,
Brian R. Kann
1   Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
› Author Affiliations
Further Information

Publication History

Publication Date:
02 April 2019 (online)

Abstract

The proximity of the colon and rectum to the organs of the urologic system virtually ensures that iatrogenic urologic injuries become a distinct possibility during complex colorectal surgical procedures. An intimate knowledge of urogenital anatomy as well as strategies for identification and repair of potential injuries is of paramount importance. Attention is mandated when operating within the narrow confines of the pelvis, as this is where these structures are most at risk. The ureters are at highest risk of injury, followed by the bladder and urethra. The nature of these injuries encompasses both functional and mechanical morbidities. Patient factors, including prior pelvic surgery, radiation, inflammatory bowel disease, infectious processes, and urogenital abnormalities all increase the risk of injury. As colorectal surgeons encounter an increasing number of patients with the above risk factors, it is important to be familiar with the various urologic injury patterns, their diagnosis, and appropriate management.

Financial Disclosure

The authors have no financial disclosure relevant to the materials presented.


 
  • References

  • 1 Delacroix Jr SE, Winters JC. Urinary tract injures: recognition and management. Clin Colon Rectal Surg 2010; 23 (02) 104-112
  • 2 Althumairi AA, Efron JE. Genitourinary considerations in reoperative and complex colorectal surgery. Clin Colon Rectal Surg 2016; 29 (02) 145-151
  • 3 Kyzer S, Gordon PH. The prophylactic use of ureteral catheters during colorectal operations. Am Surg 1994; 60 (03) 212-216
  • 4 Selzman AA, Spirnak JP. Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol 1996; 155 (03) 878-881
  • 5 Rose J, Schneider C, Yildirim C, Geers P, Scheidbach H, Köckerling F. Complications in laparoscopic colorectal surgery: results of a multicentre trial. Tech Coloproctol 2004; 8 (01) (Suppl. 01) s25-s28
  • 6 Leff EI, Groff W, Rubin RJ, Eisenstat TE, Salvati EP. Use of ureteral catheters in colonic and rectal surgery. Dis Colon Rectum 1982; 25 (05) 457-460
  • 7 Halabi WJ, Jafari MD, Nguyen VQ. , et al. Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum 2014; 57 (02) 179-186
  • 8 Andersen P, Andersen LM, Iversen LH. Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches. Surg Endosc 2015; 29 (06) 1406-1412
  • 9 Zafar SN, Ahaghotu CA, Libuit L. , et al. Ureteral injury after laparoscopic versus open colectomy. JSLS 2014; 18 (03) e2014.00158
  • 10 Sawkar HP, Kim DY, Thum DJ. , et al. Frequency of lower urinary tract injury after gastrointestinal surgery in the nationwide inpatient sample database. Am Surg 2014; 80 (12) 1216-1221
  • 11 Palaniappa NC, Telem DA, Ranasinghe NE, Divino CM. Incidence of iatrogenic ureteral injury after laparoscopic colectomy. Arch Surg 2012; 147 (03) 267-271
  • 12 Speicher PJ, Goldsmith ZG, Nussbaum DP, Turley RS, Peterson AC, Mantyh CR. Ureteral stenting in laparoscopic colorectal surgery. J Surg Res 2014; 190 (01) 98-103
  • 13 Al-Awadi K, Kehinde EO, Al-Hunayan A, Al-Khayat A. Iatrogenic ureteric injuries: incidence, aetiological factors, and the effect of early management on subsequent outcome. Int Urol Nephrol 2005; 37 (02) 235-241
  • 14 da Silva G, Boutros M, Wexner SD. Role of prophylactic ureteric stents in colorectal surgery. Asian J Endosc Surg 2012; 5 (03) 105-110
  • 15 Pathak RA, Taylor AS, Alford S. , et al. Urologic-induced complications of prophylactic ureteral localization stent placement for colorectal surgery cases. J Laparoendosc Adv Surg Tech A 2015; 25 (12) 966-970
  • 16 Coakley KM, Kasten KR, Sims SM, Prasad T, Heniford BT, Davis BR. Prophylactic ureteral catheters for colectomy: a National Surgical Quality Improvement Program-based analysis. Dis Colon Rectum 2018; 61 (01) 84-88
  • 17 Redan JA, McCarus SD. Protect the ureters. JSLS 2009; 13 (02) 139-141
  • 18 Summerton DJ, Kitrey ND, Lumen N, Serafetinidis E, Djakovic N. ; European Association of Urology. EAU guidelines on iatrogenic trauma. Eur Urol 2012; 62 (04) 628-639
  • 19 Brandes S, Coburn M, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 2004; 94 (03) 277-289
  • 20 Moore EE, Shackford SR, Pachter HL. , et al. Organ injury scaling: spleen, liver, and kidney. J Trauma 1989; 29 (12) 1664-1666
  • 21 Armatys SA, Mellon MJ, Beck SD, Koch MO, Foster RS, Bihrle R. Use of ileum as ureteral replacement in urological reconstruction. J Urol 2009; 181 (01) 177-181
  • 22 Benson MC, Ring KS, Olsson CA. Ureteral reconstruction and bypass: experience with ileal interposition, the Boari flap-psoas hitch and renal autotransplantation. J Urol 1990; 143 (01) 20-23
  • 23 Bjurlin MA, Fantus RJ. Retroperitoneal injuries: kidney and ureter. In: Cameron JL, Cameron AM. , eds. Current Surgical Therapy, 11th ed. Philadelphia, PA: Elsevier; 2017: 1200-1206
  • 24 Mileski WJ, Joehl RJ, Rege RV, Nahrwold DL. One-stage resection and anastomosis in the management of colovesical fistula. Am J Surg 1987; 153 (01) 75-79
  • 25 Gomez RG, Ceballos L, Coburn M. , et al. Consensus statement on bladder injuries. BJU Int 2004; 94 (01) 27-32
  • 26 Moore EE, Cogbill TH, Jurkovich GJ. , et al. Organ injury scaling. III: chest wall, abdominal vascular, ureter, bladder, and urethra. J Trauma 1992; 33 (03) 337-339
  • 27 Rouanet P, Mourregot A, Azar CC. , et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 2013; 56 (04) 408-415
  • 28 Atallah S, Albert M, Monson JR. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol 2016; 20 (07) 483-494
  • 29 Atallah S, Martin-Perez B, Drake J, Stotland P, Ashamalla S, Albert M. The use of a lighted stent as a method for identifying the urethra in male patients undergoing transanal total mesorectal excision: a video demonstration. Tech Coloproctol 2015; 19 (06) 375
  • 30 Zmora O, Tulchinsky H, Gur E, Goldman G, Klausner JM, Rabau M. Gracilis muscle transposition for fistulas between the rectum and urethra or vagina. Dis Colon Rectum 2006; 49 (09) 1316-1321
  • 31 Bruce RG, El-Galley RE, Galloway NT. Use of rectus abdominis muscle flap for the treatment of complex and refractory urethrovaginal fistulas. J Urol 2000; 163 (04) 1212-1215
  • 32 Fengler SA, Abcarian H. The York Mason approach to repair of iatrogenic rectourinary fistulae. Am J Surg 1997; 173 (03) 213-217