title: Prophylactic pre-operative bilateral ureteric catheters for major gynaecological surgery.
abstract: OBJECTIVE
  The use of prophylactic pre-operative bilateral ureteric catheters for major gynaecological surgery is controversial. The aim of this study was to investigate the frequency of ureteric catheter-associated morbidity in our Unit, where systematic pre-operative ureteric catheterisation is performed.
  
  
  METHODS
  We conducted a retrospective casenote review of 337 gynaecology patients undergoing laparotomy at Salford Royal Hospital between January 2007 and September 2010.
  
  
  RESULTS
  The mean age was 56.36 (range 17-89). Procedures included TAH BSO (n = 249, 74 %), BSO (n = 17, 5 %), radical hysterectomy (n = 36, 11 %), and other (n = 35, 10 %), for indications of ovarian (n = 189, 56 %), uterine (n = 88, 26 %) or cervical cancer (n = 18, 5.3 %), massive fibroids (n = 27, 8 %), severe endometriosis (n = 6, 1.78 %), or other (n = 9, 2.67 %). Bilateral ureteric catheters were attempted in most patients and successfully placed in 315/337 (93 %) patients. In 22 patients (7 %), either no ureteric catheters or a single ureteric catheter was placed due to pre-existing ureteric anomaly, technical difficulty, or surgeon choice. Bilateral ureteric catheterisation took an average of 5.4 min (SD 2.0, range 3.2-9.2) for an experienced consultant or 8.4 min (SD 3.9, range 6.4-18.6) for an SpR trainee to complete. There were no intra-operative ureteric complications. Post-operative complications included urinary tract infection (5/337 patients, 1.48 %), acute renal failure (2/337, 0.6 %), and uretero-vaginal fistulae (1/337 patients, 0.3 %).
  
  
  CONCLUSIONS
  Prophylactic pre-operative ureteric catheters are quick and easy to insert and associated with low complication rates. Routine use before major gynaecological surgery can expedite intra-operative identification of the ureters and may reduce accidental ureteric injury.
authors.affiliation: Department of Obstetrics and Gynaecology, Salford Royal Hospitals NHS Trust, Salford, UK.
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Merritt
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Crosbie
authors.forename: Judith
authors.initials: J
authors.lastname: Charova
authors.forename: Josephine
authors.initials: J
authors.lastname: Achiampong
authors.forename: Ilze
authors.initials: I
authors.lastname: Zommere
authors.forename: Brett
authors.initials: B
authors.lastname: Winter-Roach
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Slade
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D011300:Preoperative Care / Q000009:adverse effects*; D012189:Retrospective Studies; D014513:Ureter; D014515:Ureteral Diseases / Q000209:etiology; D014546:Urinary Catheterization / Q000009:adverse effects*; D014548:Urinary Fistula / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology; D014624:Vaginal Fistula / Q000209:etiology; D055815:Young Adult