IATROGENIC URETERAL INJURIES IN COLORECTAL SURGERIES: A RETROSPECTIVE STUDY FROM A TERTIARY UNIVERSITY HOSPITAL

Introduction Iatrogenic ureteral injuries (IUI) are rare surgical complications but are associated with high morbidity, with an incidence ranging from 0.15% to 1.0%. They are most commonly observed in gynecological and colorectal surgeries. Risk factors include previous pelvic surgeries, advanced colorectal cancer (CRC), radiotherapy, inflammatory bowel disease, infectious processes, and urogenital abnormalities.

Objective To evaluate UIU in coloproctological surgeries performed at a tertiary hospital.

Method A retrospective analysis of medical records of patients who presented IUI during elective colorectal surgeries at the Hospital das Clínicas of Unicamp, from 2004 to 2022. The following were analyzed: age, sex, race, body mass index (BMI), underlying disease, predisposing factors, type of surgery performed and access route, characteristics and location of the injuries, time to diagnosis, treatment, and complications.

Results A total of 2,312 abdominopelvic surgeries were performed, 1,998 via open surgery and 314 via laparoscopic surgery, with 19 cases of IUI, corresponding to 0.82%. The average age of the patients was 55.6 years; 57.9% were male, and 89.5% were white. Overweight predominated among the patients, with 52.6%, and 73.7% had a history of abdominal surgery. Rectal adenocarcinoma was the most common disease (47.4%), followed by tumor recurrences (21%). The most common surgery performed was resection of the rectosigmoid (57.8%). IUIs were observed in 1.91% of laparoscopic surgeries and 0.65% of open surgeries. The most frequent location of the IUI was on the left (52.6%), with 89.5% involving the distal portion of the ureter. The main mechanism of injury was sectioning (57.8%). The diagnosis was made intraoperatively in 12 patients (63.2%). Different surgical techniques were used for correction, with a predominance of ureteral reimplantation (36.8%) and termino-terminal ureteral anastomosis (21.0%). Complications after surgical treatment of the IUI were frequent (47.4%), and one patient died due to a non-surgical cause. In the long-term follow-up, seven patients are under follow-up, seven died due to disease progression, and five lost follow-ups.

Conclusion IUI in coloproctological surgeries occurred in 0.82% of cases. They were diagnosed late in 46.8% of patients, with high morbidity. The main risk factor was CRC.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025