Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
BJU Int. 2023 May;131(5):540-552. doi: 10.1111/bju.15913. Epub 2022 Oct 18.
To assess the incidence of ureteric injuries, clinical value of prophylactic ureteric stenting and impact of intra- or postoperative detection of ureteric injuries in patients treated with gynaecological or colorectal surgery.
Multiple databases were searched for articles published before September 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Studies were deemed eligible if they evaluated the differences in the rate of ureteric injuries between laparoscopic and open surgery, prophylactic ureteric stenting or not, and those of final treatment success between intra- and postoperative detection in patients who underwent gynaecological or colorectal surgery.
Overall, 46 studies were eligible for this meta-analysis. Compared to open surgery, laparoscopic hysterectomy was associated with a higher incidence of ureteric injuries (pooled odds ratio [OR] 2.12, 95% confidence interval [CI] 1.71-2.62), but there was no statistically significant difference in colectomy (pooled OR 0.89, 95% CI 0.77-1.03). Prophylactic ureteric stenting was associated with a lower incidence of ureteric injuries during gynaecological surgery (pooled OR 0.61, 95% CI 0.39-0.96). The number needed to perform ureteric stenting to prevent one ureteric injury was 224 in gynaecological surgery. On the other hand, prophylactic ureteric stenting did not reduce the risk of ureteric injuries during colorectal surgery. Intraoperative detection of a ureteric injury was associated with a lower rate of complication management failure compared to postoperative detection (pooled OR 0.22, 95% CI 0.12-0.41).
Laparoscopic hysterectomy seems to be associated with a higher rate of ureteric injuries compared to an open approach. Prophylactic ureteric stenting seems to reduce this risk during gynaecological surgery. Intraoperative detection of a ureteric injury during abdominal/pelvic surgery improves outcomes, suggesting the need for awareness and proactive problem identification. Further well-designed studies assessing the candidates who are more likely to benefit from prophylactic ureteric stenting including cost analysis are needed.
评估妇科或结直肠手术后输尿管损伤的发生率、预防性输尿管支架置入的临床价值，以及术中或术后发现输尿管损伤对患者的影响。
根据系统评价和荟萃分析的首选报告项目，检索了截至 2021 年 9 月之前发表的文章。如果研究评估了腹腔镜和开放手术、预防性输尿管支架置入或不置入以及妇科或结直肠手术后术中或术后发现输尿管损伤对最终治疗成功的影响，则认为这些研究符合纳入标准。
共有 46 项研究符合本荟萃分析的纳入标准。与开放手术相比，腹腔镜子宫切除术与输尿管损伤发生率较高相关（汇总优势比 [OR] 2.12，95%置信区间 [CI] 1.71-2.62），但结直肠切除术无统计学差异（汇总 OR 0.89，95% CI 0.77-1.03）。预防性输尿管支架置入与妇科手术中输尿管损伤发生率较低相关（汇总 OR 0.61，95% CI 0.39-0.96）。在妇科手术中，为预防 1 例输尿管损伤，需要进行输尿管支架置入的数量为 224 例。另一方面，预防性输尿管支架置入并不能降低结直肠手术中输尿管损伤的风险。与术后发现相比，术中发现输尿管损伤与并发症管理失败的风险较低相关（汇总 OR 0.22，95% CI 0.12-0.41）。
与开放手术相比，腹腔镜子宫切除术似乎与输尿管损伤发生率较高相关。预防性输尿管支架置入似乎可以降低妇科手术中的这种风险。在腹部/骨盆手术中术中发现输尿管损伤可改善结局，这表明需要提高认识并主动识别问题。需要进一步设计良好的研究来评估哪些患者更有可能从预防性输尿管支架置入中获益，包括成本分析。
