Ureteral complications during colorectal surgery

Ureteral complications occur rarely during colorectal surgery (0.3 to 1.5%), are mainly diagnosed postoperatively (50-70%), and result in both short- and long-term morbidity. The objective of this update was to report on prevention, diagnosis, and treatment options for ureteral injuries that occur during colorectal surgery. For prevention, it is essential to identify at-risk patients preoperatively. Routine prophylactic insertion of a double-J catheter is not recommended. Intra-operatively, non-invasive techniques to aid in locating the ureters based on intravenous injection of methylene blue or intra-ureteral injection of indocyanine green have been reported. If ureteral injury is diagnosed intra-operatively, direct repair should be performed over a ureteral stent, combined with catheter drainage of the bladder for 5 to 7 days. In case of postoperative diagnosis, urinary diversion can be performed using a double-J catheter, a mono-J catheter, or by insertion of a percutaneous nephrostomy. Ureteral repair will be performed secondarily depending on the location of the injury and the size of the defect. For ureteral injuries in the pelvis, uretero-vesical re-implantation with or without a psoas-bladder hitch procedure may be proposed. For ureteral injuries at the lumbar or iliac levels, segmental resection with uretero-ureteral anastomosis, or possibly with ileal or appendiculoplasty, may be performed. The main complications after ureteral injury repair are anastomotic leakage and ureteral stricture. Uretero-vesical re-implantation techniques appear to be less likely to cause anastomotic leakage than direct uretero-ureteral anastomoses.