Prophylactic ureteral catheterization in colon surgery

Abstract

PURPOSE: The preoperative placement of prophylactic ureteral catheters in operations of the distal colon is both commonplace and controversial. We assessed the frequency, safety, and effectiveness of their use over a five and one-half-year period in a teaching hospital. METHODS: The charts of 561 consecutive patients who underwent sigmoid or rectosigmoid colectomy from 1986 to 1991 were analyzed for age, sex, diagnosis, type of colectomy, placement of ureteral catheters, and ureteral complications. RESULTS: Ureteral catheterization was attempted in 92 patients (16.4 percent); it was successful bilaterally in 80 patients (87 percent) and unilaterally in an additional 10 patients (98 percent). Four (0.71 percent) transmural ureteral injuries were identified. Two surgical injuries (0.43 percent) occurred in the 469 patients without prophylactic catheter placement (95 percent confidence interval = 0.00549–0.0153). Two injuries (2.2 percent), consisting of one surgical injury and one iatrogenic injury directly related to catheter placement, occurred in the 92 patients with prophylactic catheters (95 percent confidence interval = 0.00262–0.0764). This latter injury resulting from catheter placement represents a rate of 1.1 percent per patient and 0.55 percent per ureteral catheterization attempted. Using a 24-hour staged removal, these catheterizations were associated with a 0 percent incidence of reflux anuria. CONCLUSIONS: Experienced surgeons requested prophylactic ureteral catheter placement in 16.4 percent of their sigmoid and rectosigmoid colectomies. The risk of ureteral injury (1.1 percent) as a direct result of catheter insertion is small, but not insignificant. Prophylactic ureteral catheters do not assure the prevention of transmural ureteral injuries, but may assist in their immediate recognition.