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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

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Abstract

Iatrogenic ureteral injury (IUI) during colorectal surgery is a rare complication but related to a serious burden of morbidity. This comprehensive and systematic review aims to provide a critical overview of the most recent literature about IUI prevention techniques in colorectal surgery. We performed a comprehensive and systematic review of studies published from 2000 to 2022 and assessed the use of techniques for ureteral injury prevention and intraoperative localization. 26 publications were included, divided into stent-based (prophylactic/lighted ureteral stent and near-infrared fluorescent ureteral catheter [PUS/LUS/NIRFUC]) and fluorescent dye (FD) groups. Costs, the percentage and number of IUIs detected, reported limitations, complication rates and other outcome points were compared. The IUI incidence rate ranged from 0 to 1.9% (mean 0.5%) and 0 to 1.2% (mean 0.3%) in the PUS/LUS/NIRFUC and FD groups, respectively. The acute kidney injury (AKI) and urinary tact infection (UTI) incidence rate ranged from 0.4 to 32.6% and 0 to 17.3%, respectively, in the PUS/LUS/NIRFUC group and 0–15% and 0–6.3%, respectively, in the FD group. Many other complications were also compared and descriptively analyzed (length-of-stay, mortality, etc.). These techniques appear to be feasible and safe in select patients with a high risk of IUI, but the delineation of reliable guidelines for preventing IUI will require more randomized controlled trials.

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Data availability statement

The datasets generated during and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. General Surgical Oncology Department, IRCCS CRO di Aviano (Istituto Nazionale Tumori), Aviano, Italy

    Pier Paolo Brollo

  2. General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy

    Pier Paolo Brollo, Alessandro Puggioni, Francesco Tumminelli, Antonio Colangelo, Vittorio Cherchi & Vittorio Bresadola

  3. General Surgery Department, Hospital of Pordenone, Pordenone, Italy

    Francesco Tumminelli, Antonio Colangelo & Carlo Biddau

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Contributions

PPB, AP, FT, AC and VB: equally contributed to the conceptualization and design of the study; PPB, CB and AP: analyzed the data. PPB and AP: wrote the first and final drafts of the review; VB, VC, AC and FC: supervised the manuscript; VB, CB and VC: offered significant intellectual contributions. All the authors have read and approved the final version of the manuscript.

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Correspondence to Pier Paolo Brollo.

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Brollo, P.P., Puggioni, A., Tumminelli, F. et al. Preventing iatrogenic ureteral injury in colorectal surgery: a comprehensive and systematic review of the last 2 decades of literature and future perspectives. Surg Today 54, 291–309 (2024). https://doi.org/10.1007/s00595-022-02639-9

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