BJU Int. 2022 Oct 5. doi: 10.1111/bju.15913. Online ahead of print.
ABSTRACT
OBJECTIVES: To assess the incidence of ureteral injuries, clinical value of prophylactic ureteral stenting, and impact of intraoperative or postoperative detection of ureteral injuries in patients treated with gynecological or colorectal surgery.
METHODS: Multiple databases were searched for articles published before September 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Studies were deemed eligible if they evaluated the differences in the rate of ureteral injuries between laparoscopic and open surgery, prophylactic ureteral stenting or not, and those of final treatment success between intraoperative and postoperative detection in patients who underwent gynecological or colorectal surgery.
RESULTS: Overall, 46 studies were eligible for this meta-analysis. Compared to open surgery, laparoscopic hysterectomy was associated with a higher incidence of ureteral injuries (pooled odds ratio [OR]; 2.12, 95% confidence intervals [CI]; 1.71-2.62), but there was no statistically significant difference in colectomy (pooled OR; 0.89, 95% CI; 0.77-1.03). Prophylactic ureteral stenting was associated with a lower incidence of ureteral injuries during gynecological surgery (pooled OR; 0.61, 95%CI; 0.39-0.96). The number needed to perform ureteral stenting to prevent one ureteral injury was 224 in gynecological surgery. On the other hand, prophylactic ureteral stenting did not reduce the risk of ureteral injuries during colorectal surgery. Intraoperative detection of a ureteral injury was associated with a lower rate of complication management failure compared to postoperative detection (pooled OR; 0.22, 95%CI; 0.12-0.41).
CONCLUSIONS: Laparoscopic hysterectomy seems to be associated with a higher rate of ureteral injuries compared to an open approach. Prophylactic ureteral stenting seems to reduce this risk during gynecological surgery. Intraoperative detection of a ureteral injury during abdominal/pelvic surgery improves outcomes, suggesting the need for awareness and proactive problem identification. Further well-designed studies assessing the candidates who are more likely to benefit from prophylactic ureteral stenting including cost analysis are needed.
PMID:36196670 | DOI:10.1111/bju.15913
