Trends in ureteral surgery on an academic gynecologic oncology service.

OBJECTIVE: To describe the incidence, complications, and trends associated with ureteral surgeries on a gynecologic oncology service in the context of a fellowship training program over a 24-year period. METHODS: We conducted a retrospective cohort analysis of ureteral surgeries by gynecologic oncologists at either Moffitt Cancer Center or Tampa General Hospital from 1997 to 2020. Patient characteristics, predisposing factors, location and type of injury, repair method, postoperative management and complications were abstracted from the medical record. The recent cohort (2005-2020) was compared to our prior series (1997-2004). RESULTS: Eighty-eight cases were included. The average number of ureteral surgeries per year decreased from 5.75 (1997-2004) to 2.63 (2005-2020). Of 46 iatrogenic injuries, 45 were recognized and repaired intraoperatively. Ureteral transection was the most common type (85% [39 of 46]) and the distal 5 cm was the most common location of injury (63% [29 of 46]). Ureteroneocystostomy was the most common method of repair (83% [73 of 88]). Postoperative management, including stenting and imaging, has not changed significantly. Length of urinary catheter usage decreased in the recent cohort without associated complications. Five patients had major postoperative complications and 4 involved the urinary tract. Of those with follow-up, 96% (66 of 69) of ureteroneocystostomies and 75% (9 of 12) of ureteroureterostomies had radiologically normal urinary tracts. CONCLUSIONS: Ureteral surgery is necessary in the case of injury or involvement with invasive disease. There has been a decrease in number of procedures. Ureteroneocystostomy has remained the most common method of reconstruction for both injury and resection with acceptable postoperative complication rates.

Suprapubic versus transurethral bladder catheterization following pelvic surgery.

PURPOSE OF REVIEW: There is uncertainty regarding the optimal method of achieving bladder drainage at the time of gynaecologic surgery. As both transurethral catheterization (TUC) and suprapubic catheterization (SPC) have the potential to cause harm, it is important that gynaecologists have accurate evidence upon which to base their bladder drainage policy. RECENT FINDINGS: Several clinical trials and meta-analyses have compared TUC with SPC in abdominal and pelvic surgery. Most recently, a large meta-analysis pooled the results of 12 gynaecological trials and found that the use of SPC leads to fewer urinary tract infections (UTIs) without any major complications and without increasing the duration of catheterization or length of hospital stay. SUMMARY: Robust evidence shows that SPC use leads to fewer UTIs when compared with TUC use in gynaecologic surgery. However, SPC use is associated with an increased incidence of minor complications. Future research should aim to assess the acceptability of both SPC and TUC to patients who are undergoing gynaecologic surgery. The quality of similar data in relation to rectal pelvic surgery is poor in comparison to the data on gynaecologic surgery.