URETERAL INJURIES IN COLORETAL SURGERY - BIBLIOGRAPHIC REVIEW (Atena Editora)

Abstract

Introduction: Iatrogenic ureteral injuries (UII) are surgical complications associated with high morbidity, with an incidence ranging from 0.3% to 1.5%, and most commonly observed in gynecological and colorectal surgeries. Objective: To evaluate the factors that influenced LUI in colorectal surgeries and their history of diagnosis and treatment performed. Method: Bibliographic review carried out on the PubMed platform, 29 articles were selected, published between 2005 and 2021. Results: LUI were more frequently observed in the distal ureter and in women. Among the risk factors, the anatomical ones stand out (adherence of the ureter to the peritoneum, similarity with the ovarian ligaments and uterine artery and its proximity to important pelvic structures), anatomopathological (congenital anomalies, pelvic tumors, colorectal cancer, previous surgery and irradiation). pelvic, endometriosis, inflammatory/infectious processes and inflammatory bowel disease) and technical (bleeding in the operative field, advanced tumor, malnutrition and surgeons on a learning curve). As protective factors, right and transverse colon colectomy and, in some studies, videolaparoscopic surgery were identified, the latter not being a consensus. The indication of prophylactic ureteral catheter is not clear in the literature. They are usually indicated in reoperations, large pelvic tumors, laparoscopic surgeries, previous radiotherapy, diverticulitis, occurrence of fistulas, Crohn's disease and obesity. In the immediate suspicion of LUI, careful intraoperative visual inspection and use of retrograde or anterograde ureteropyelography were reported. In late diagnosis, computed tomography with intravenous contrast was the most used exam. In the treatment of LUI, the type of surgical correction depended on the severity and location of the lesion. Conclusion: Colorectal cancer, neoadjuvant radiotherapy and chemotherapy, pelvic recurrence, malnutrition and surgery performed in teaching hospitals were important risk factors for LUI. The use of an adequate and judicious surgical technique and the early diagnosis of ureteral lesions were more decisive factors than the surgical approach used.