Preoperative evaluation and surgical planning can help prevent ureteral injuries during robotic-assisted laparoscopic prostatectomy, according to investigators who have identified characteristics that put patients at risk for this complication.

Noting a paucity of existing data on ureteral injuries sustained during robotic prostatectomy, Mani Menon, MD, and colleagues from the Vattikuti Urology Institute at Henry Ford Hospital in Detroit tracked 6,442 consecutive men who underwent robotic prostatectomy at the facility between January 2001 and June 2013. All operations were performed by one of five surgeons.

Only three patients sustained ureteral injuries (complete ureteral transection) during surgery, resulting in a 0.046% rate of ureteral injury. One of the men had to be readmitted for further treatment.

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The two surgeons involved in these three cases had each already performed more than 1,000 such operations when the injuries occurred. In a Henry Ford Health System statement, Dr. Menon noted that this number was well beyond the accepted learning curve of 100 cases.

Dr. Menon’s group found that all three patients had had risk factors predisposing them to ureteral injury, such as history of infection, abdominal surgery, radiation treatment, enlarged prostates, and prior transurethral resection of the prostate.

The researchers concluded in The Journal of Endourology that although ureteral injuries are uncommon in robotic prostatectomy, high-risk patients can be identified and measures can be taken preoperatively or intraoperatively to further reduce the odds of injury and the subsequent need for additional procedures after prostatectomy.