PROPHYLACTIC URETERAL CATHETERIZATION IN COLON SURGERY - A 5-YEAR REVIEW

PURPOSE: The preoperative placement of prophylactic ureteral catheters in operations of the distal colon is both commonplace and controversi al. We assessedthe frequency, safety, and effectiveness of their use o ver a five and one-half-year period in a teaching hospital. METHODS: T he charts of 561 consecutive patients who underwent sigmoid or rectosi gmoid colectomy from 1986 to 1991 wereanalyzed for age, sex, diagnosis , type of colectomy, placement of ureteral catheters, and ureteral com plications. RESULTS: Ureteral catheterization was attempted in 92 pati ents (16.4 percent); it was successful bilaterally in 80 patients (87 percent) and unilaterally in an additional 10 patients (98 percent). F our (0.71 percent) transmural ureteral injuries were identified. Two s urgicalinjuries (0.43 percent) occurred in the 469 patients without pr ophylactic catheter placement (95 percent confidence interval = 0.0054 9-0.0153). Two injuries (2.2 percent), consisting of one surgical inju ry and one iatrogenic injury directly related to catheter placement, o ccurred in the 92 patients with prophylactic catheters (95 percent con fidence interval = 0.00262-0.0764). This latter injury resulting from catheter placement represents a rate of 1.1 percent per patient and 0. 55 percent per ureteral catheterization attempted. Using a 24-hour sta ged removal, these catheterizations were associated with a 0 percent i ncidence of reflux anuria. CONCLUSIONS: Experienced surgeons requested prophylactic ureteral catheter placement in 16.4 percent of their sig moid and rectosigmoid colectomies. The risk of ureteral injury (1.1 pe rcent) as a direct result of catheter insertion is small, but not insi gnificant. Prophylactic ureteralcatheters do not assure the prevention of transmural ureteral injuries, but may assist in their immediate re cognition.