The Application of Ureteral Catheter in Complicated Gynecological Laparoscopic Surgery for the Prevention of Ureteral Injury / 中国微创外科杂志

Objective To investigate the application of ureteral catheter in complicated gynecological laparoscopic surgery for the prevention of ureteral injury . Methods A total of 182 cases of gynecological laparoscopic surgery performed from January 2009 to November 2011 were selected as study group .Bilateral ureteral catheters were inserted under cystoscopy , and then laparoscopic surgery was performed under the instruction of the catheter .The catheter was immediately removed after the surgery .A total of 200 cases of laparoscopic surgery were selected as control group and preoperative ureteral catheterization was not applied in this group .The incidence rate of ureteral injury was compared between the two groups . Results The success rate of bilateral ureteral catheterization in the study group was 98.9%(180/182)and no ureteral injury occurred .In the control group, ureteral injury was found in 2 cases, which were converted to open surgery for ureter repair and double J stent was retained .The 2 cases recovered 2 months after the surgery.Bladder injury was found in 2 cases during the surgery , which received immediate repair assisted by surgeons from the department of urinary surgery and recovered 2 months after postoperative catheterization . No statistical difference was found in complication rate between the two groups ( P=0.125 ) . Conclusion The application of ureteral catheterization in complicated gynecological laparoscopic surgery can reduce the risk of intraoperative ureteral injury .

The Evaluation of a Dissolvable Ureteral Catheter in a Rabbit Model / 대한비뇨기과학회지

PROPOSE: Ureteral stents are commonly placed after routine ureteroscopic procedures to prevent acute obstruction. However, stents can cause significant symptoms and they can require a secondary procedure for removal; further, they may possibly be forgotten. In order to overcome these problems, a temporary ureteral drainage stent capable of dissolving spontaneously was developed to evaluate the tissue reaction and toxicity. MATERIALS AND METHODS: We developed a dissolvable ureteral catheter composed of polydioxanone (PDO). We evaluated the toxicity and tissue reaction by hematologic (CBC, aminotransferase/alanine transaminase (AST/ALT), blood urea nitrogen, creatinine (BUN, Cr), alkaline phosphatase) and histologic examination (ureter, kidney and liver tissue). Twelve rabbits were placed into groups of four rabbits each: the uninserted control group, group I that had a dissolvable ureteral catheter inserted with harvest at four weeks, group II that had a dissolvable ureteral catheter inserted with harvest at eight weeks, and group III that had a dissolvable ureteral catheter inserted with harvest at twelve weeks. RESULTS: On histologic examination, the ureter had a normal appearance of transitional cells and it contained the dissolvable ureteral catheter in the ureteral lumen without any inflammatory change. The ureteral surface cells appeared normal after contact with the dissolvable ureteral catheter during the 12 weeks. Liver and kidney tissue showed mild focal inflammatory change, but no definitive difference was noted between the control and groups I, II and III. On the hematologic examination, there was no significant change of the value of CBC, AST/ALT, BUN, Cr and alkaline phosphatase due to the inserted dissolvable ureteral catheter during the 12 weeks. CONCLUSIONS: A dissolvable ureteral catheter appeared to have no toxic effect, as evidenced by histological and hematological examination. However, further study is warranted in order to overcome the catheter's limitations like for its flexibility.

Clinical Value of Prophylactic Ureteral Stent Indwelling During Laparoscopic Colorectal Surgery

One of the hazards of colorectal surgery is ureteric injury. The aim of this study was to evaluate the results of ureteric catheterization regarding its safety and operative time. One-hundred sixty two patients underwent laparoscopic segmental left or right colectomy. The mean time for placement of ureteric catheters was 11.4 min for the right hemicolectomy and 11.3 min for the left hemicolectomy group. The mean preparation times for right hemicolectomy and left hemicolectomy (group 1 vs. group 2) were 54.7 vs. 39.1 min (p=0.00001) and 61.4 vs. 47.6 min (p=0.006), respectively. There were no significant differences in the laparoscopic operative time in either the right or left hemicolectomy groups (134.2 vs. 145.5 min and 198.4 vs. 170.1 min, respectively). There was no morbidity directly related to the ureteric catheters and in fact the incidence of postoperative urinary tract infection was lower in group 1 (1.5%) than in group 2 (5.3%) (p<0.05). Although the use of ureteric catheters added a mean of 11.3 min to the surgical procedure, the overall anesthetic time for right hemicolectomy was no longer than that for left hemicolectomy. The morbidity rate was quite acceptable. Thus, ureteric catheters may be useful in selected cases of laparoscopic left and right colorectal resections.