Outcomes of Prophylactic Ureteral Catheterization for Ureteral Identification During Non-Urologic Surgery

Abstract

Introduction: Prophylactic ureteral catheterization (PUC) is routinely performed during non-urologic procedures to avoid iatrogenic ureteral injury. However, evidence of its benefit is conflicting, as data suggest that the rate of ureteral injury is unchanged and there is lack of data reporting associated complications. The purpose of this study was to evaluate the outcomes of routine PUC in non-urologic surgeries. Methods: All consecutive patients who underwent PUC during non-urologic procedures between January 2019 and March 2024 were reviewed. Demographic, clinical, and perioperative characteristics, including ureteral injury rates, were reviewed. Complications within 90 days were divided into low-grade (urinary tract infection [UTI], gross hematuria, and flank pain) and high-grade (new or worsening hydronephrosis and need for nephrostomy or indwelling stent). Logistic regression was performed to identify predictors of PUC-related complications. Results: Among 233 patients, 63.5% were female. Median age and body mass index were 57 years and 28, respectively. Patient history included neoadjuvant chemotherapy in 54 (23%), pelvic radiation in 43 (18%), and pelvic surgery in 119 (51%). Surgery types included colorectal (75.1%), gynecological (14.2%), or both (10.7%). A total of 101 urologic complications affected 43% of patients, including UTI (22.3%), gross hematuria (24.4%), flank pain (10.7%), new/worsening hydronephrosis (9.9%), and need for nephrostomy tube/stent (1.3%). Intraoperative ureteral injury rate was 3.9%. On multivariate analysis, prior pelvic radiation was significantly associated with the occurrence of high-grade complications (odds ratio 3.29, 95% CI 1.04, 10.43). Conclusion: PUC during non-urologic procedures is associated with a small but significant risk of urologic complications and does not eliminate the risk of ureteral injury. Prior pelvic radiation is a significant risk factor for PUC-related complications.