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BACKGROUND:The purpose of this study is to quantify and categorize genitourinary injuries during colorectal surgery.
METHODS:We retrospectively reviewed patients who underwent colorectal surgery and developed iatrogenic genitourinary complications requiring surgical repair between 2003-2013. Endpoints included GU repair failures.
RESULTS:There were 75 patients in this series, with a mean age of 57.5 years (22-91) at time of surgery and median follow-up of 16.7 months (0-127). Sixty-four patients had single GU repairs and 11 patients had multiple GU repairs, with 18 patients having a failure of their initial repair. Colorectal procedures included colectomies (16), lower abdominal resections (15), lower abdominal and abdominoperineal resections with total abdominal hysterectomies and bilateral salpingo-oophorectomies (13), and abdominoperineal resections (9). The most common initial GU repairs were cystorrhaphy (24), ureteroureterostomy (22), ureteroneocystotomy with psoas hitch (12), and ureteroneocystotomy (11). Secondary GU repairs included stent placement or PCN for persistent ureteral leak (5), fistula repair (3) stent placement or cystorrhaphy for persistent bladder leak (2), and repair of recurrent ureteral strictures (1). Twenty-seven patients (36%) had prior radiation and 35 patients (47%) had prior chemotherapy. Fifty patients (67%) are alive, with a 30-day mortality rate of 4%. Pre-operative radiation was associated with failure of the GU repair (11/28 vs.7/47, p=0.025). Pre-operative chemotherapy was also associated with GU repair failure (13/35 vs. 5/40, p=0.016).
CONCLUSIONS:Pre-operative radiation and chemotherapy are associated with increased repair failure rates of GU injuries during colorectal surgery.