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Genitourinary Considerations in Reoperative and Complex Colorectal Surgery
Azah A Althumairi1, Jonathan E Efron1
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Clinics in Colon and Rectal Surgery
|June 2, 2016
Summary
Genitourinary structures face injury risks during colorectal surgery, especially with complex cases. Prompt identification and repair of these injuries are vital to minimize patient morbidity.
Area of Science:
- Urology
- Colorectal Surgery
- Surgical Anatomy
Background:
- Colorectal surgery poses a risk of genitourinary structure injury.
- Risk factors include inflammation, infection, advanced cancer, radiation, and reoperation.
- Understanding anatomical proximity is key to prevention.
Purpose of the Study:
- To highlight the risk of genitourinary injuries during colorectal surgery.
- To discuss diagnostic and management strategies for these injuries.
Main Methods:
- Review of anatomical relationships between colorectal and genitourinary systems.
- Discussion of intraoperative diagnostic tools like intravenous pyelogram (IVP), fluoroscopic cystogram, and retrograde urethrogram.
- Analysis of repair techniques based on injury characteristics.
Main Results:
- Genitourinary injury incidence is low but significant in high-risk patients.
- Intraoperative imaging aids in detecting suspected injuries.
- Timely recognition and repair reduce associated morbidity.
Conclusions:
- Awareness of anatomical relationships is crucial for preventing genitourinary injuries during colorectal surgery.
- Early diagnosis and appropriate repair strategies, from primary closure to flap reconstruction, are essential for optimal outcomes.
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