Objectives. To examine the frequency of ureteral catheter usage, its e
fficacy in preventing injury, and related complications, because the p
reoperative routine placement of ureteral catheters as a prophylactic
measure to prevent ureteral injury is controversial. Methods. All majo
r gynecologic operations performed between January 1992 and December 1
994 were identified. All gynecologic procedures that were preceded by
ureteral catheter placement were also identified. A data base maintain
ed by the Department of Quality Management allowed identification of a
ll urinary tract complications and ureteral injuries. Four categories
of surgery were analyzed: exploratory laparotomy with catheters, explo
ratory laparotomy without catheters, operative laparoscopy with cathet
ers, and operative laparoscopy without catheters, The medical records
of all patients with urinary tract complications were reviewed. Result
s. Bilateral prophylactic ureteral catheterization was performed in 46
9 (15.3%) of 3071 patients. A ureteral injury occurred in 4 (0.13%) of
3071 patients. All four ureteral injuries (0.17%) occurred among 2338
patients who underwent exploratory laparotomy. None of the 733 patien
ts who underwent operative laparoscopy suffered ureteral injury. The i
ncidence of ureteral injury in patients who had ureteral catheters pla
ced before exploratory laparotomy was 2 (0.62%) of 322. Two (0.10%) of
2016 patients who did not have prophylactic ureteral catheters suffer
ed a ureteral injury. There was no statistically significant differenc
e in the incidence of ureteral injury between patients who did and pat
ients who did not undergo ureteral catheterization (P = 0.094). Conclu
sions. The use of prophylactic ureteral catheters did not affect the r
ate of ureteral injury in our patients. The very low incidence of uret
eral injury among our patients is attributed mainly to meticulous surg
ical technique. (C) 1998, Elsevier Science Inc. All rights reserved.