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Outcomes of Ureteral Injuries during Abdominopelvic Surgery With and Without Ureteral Catheterization
Peter S. Palencia, BS, Michael S. Leapman, MD, MSHS, Jaime A. Cavallo, MD, MSHS.
Department of Urology, Yale School of Medicine, New Haven, CT, USA.
BACKGROUND: Ureteral catheterization during abdominopelvic surgery may improve intraoperative ureteral identification, allowing for immediate repair and potentially improved ureteral injury outcomes. We hypothesized that compared to patients with ureteral injuries incurred during abdominopelvic surgery without ureteral catheterization, patients with ureteral injuries incurred during abdominopelvic surgery with ureteral catheterization would have fewer postoperative procedures to treat the ureteral injury, and fewer days of hospital admission in the 12 postoperative months after the index surgery.
METHODS: We retrospectively identified patients diagnosed with intraoperative ureteral injuries during abdominopelvic surgery between 2020-2024 using ICD10 codes, and divided these patients into cohorts with and without ureteral catheterization during the index procedure using CPT codes. Relevant patient preoperative, intraoperative, and postoperative variables were collected. Continuous and categorical variables were analyzed using the Mann-Whitney U and Chi-square tests using SPSS.
RESULTS: Ureteral injuries were identified in 19 catheterized and 27 non-catheterized patients. No statically significant differences in preoperative variables were identified between the two cohorts (Table 1). Intraoperative identification of ureteral injury was not statistically significantly different (Table 2). Number of relevant hospital readmissions were significantly lower in catheterized patients, but cumulative readmission days were similar (Table 2). Additional urological procedures, additional interventional radiology procedures and mortalities were not statistically different between the cohorts (Table 2).
CONCLUSIONS: Ureteral catheterization during abdominopelvic surgery is not associated with increased frequency of intraoperative identification of the ureteral injury or improved 12-month postoperative outcomes, except of fewer relevant hospital admissions. Larger prospective studies are needed to validate these findings.
Table 1. Baseline characteristics of patients with ureteral injuries | | | Ureteral catheters
n=19 | | No ureteral catheters
n=27 | | p-value |
| Age | | 64 (55, 68) | | 54 (49, 70) | | 0.87 |
| ASA Score | | 3 (2, 3) | | 3 (2, 3) | | 0.70 |
| BMI | | 34 (26, 37) | | 29 (25, 39) | | 0.75 |
| Charleson Comorbidity Score | | 3 (1.5, 5) | | 2 (0, 4) | | 0.16 |
| Operative Time (hours) | | 7.0 (5.5, 9.3) | | 4.8 (4.1, 6.7) | | 0.14 |
| Prior Chemotherapy (n; %) | | 3 (16) | | 3 (11) | | 0.89 |
| Prior Radiation (n; %) | | 0 (0) | | 0 (0) | | 1 |
| Prior Abdominopelvic Surgery (n; %) | | 8 (42) | | 16 (59) | | 0.42 |
| Values are shown as median (interquartile range) or n (%)
ASA- American Society of Anesthesiologists, BMI- Body Mass Index | | | | | | |
Table 2. Intraoperative and 12-month postoperative outcomes of ureteral injuries | | | Ureteral catheters
n=19 | | No ureteral catheters
n=27 | | p-value |
| Intraoperative UI diagnosis and repair (n; %) | | 15 (79) | | 18 (67) | | 0.36 |
| Readmissions (n; %) | | 4 (21) | | 10 (37) | | 0.001 |
| Cumulative readmission days | | 5.0 (4.0, 10.3) | | 8.0 (6.3, 16.5) | | 0.44 |
| Number urological procedures | | 1.0 (1.0, 1.5) | | 1.0 (1.0, 2.0) | | 0.63 |
| Number IR procedures | | 0 (0, 1.5) | | 0 (0, 1.0) | | 0.40 |
| Acute kidney injury (n; %) | | 2 (11) | | 3 (11) | | 0.95 |
| Urinary tract infection (n; %) | | 4 (21) | | 5 (19) | | 0.62 |
| Mortality (n; %) | | 0 (0) | | 1 (4) | | 0.40 |
| Values are shown as median (interquartile range) or n (%)
UI- Ureteral Injury, IR- Interventional Radiology | | | | | | |
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