Trends and benefits of prophylactic ureter catheters in the era of minimally invasive surgery

Background: The recent spike in ureter injury (UI) amidst the rise of minimally invasive surgery (MIS) has focused attention on the propriety of prophylactic ureter catheters (PUCs) for abdominopelvic operations. Methods: A retrospective review of PUCs for rectal cancer resection following neoadjuvant therapy, combined with a comprehensive literature review. Results: There were zero UI in the current study. Literature review revealed a nationwide spike in PUCs in the last 30 years, dependent on operation: 1) colorectal resection-increased from 1.1% to 4.4%, 2) sigmoid colectomy for diverticulitis-increased from 6.7% to 16.3%. This 2-4 fold increase parallels the rise of MIS: 15 of the 20 latest studies (75%) either combined open operations and MIS (4 studies) or focused solely on MIS (11 studies). Medial-to-lateral dissection identified as a UI risk factor. Only 20-30% of UI identified intraoperatively. Conclusions: Intraoperative UI is missed in 70-80% of cases. The prevention, identification, ease of ureter repair, and net decrease in operative time support the use of PUCs. Medial-to-lateral dissection is identified as a potential contributing factor to UI.

Automated summary

Recent increase in ureter injury (UI) with the rise of minimally invasive surgery (MIS) has raised concerns about prophylactic ureter catheters (PUCs) for abdominopelvic operations. A retrospective review of PUCs for rectal cancer resection and comprehensive literature review showed a significant nationwide increase in PUCs usage, particularly in colorectal resection and sigmoid colectomy for diverticulitis. This increase is associated with the rise of MIS and medial-to-lateral dissection is identified as a potential contributing factor to UI.