Tech Coloproctol DOI 10.1007/s10151-015-1306-5

CORRESPONDENCE

Reflex anuria: a rare complication of prophylactic ureteral catheterization T. Saleem1 • J. Bem2

Received: 31 March 2015 / Accepted: 14 April 2015 Ó Springer-Verlag Italia Srl 2015

1

Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA

later, his urine output declined significantly. On review of his chart, no identifiable nephrotoxic drugs potential for contrast nephropathy due to any recent radiologic study or intraoperative hypotensive events were noted. Some large clots in his Foley catheter were noted; subsequently, continuous bladder irrigation was instituted without a change in urine output. Fractional excretion of sodium was found to be consistent with a postrenal phenomenon. His creatinine increased to 3.6 mg/dl from 0.8 mg/dl within a span of several hours. Ultrasonography and a computed tomography scan were obtained expeditiously demonstrating mild-to-moderate bilateral hydronephrosis with bilateral periureteric stranding. Cystoscopy was subsequently performed and showed intact ureters bilaterally with mild-tomoderate bilateral hydronephrosis. Bilateral ureteral stents were placed at this time. The gentleman had brisk diuresis within the next 24 h (up to 8 l urine output), and his creatinine rapidly normalized. About 6 weeks from discharge, his stents were removed without further incident. Reflex anuria, or catheter-induced obstructive anuria [4], remains a rare but serious event after prophylactic ureteral catheterization that can result in acute renal failure. Surgeons need to be cognizant of this rare phenomenon in order to promptly recognize it in the appropriate clinical setting. Several authors recommend the use of cystoscopy and stenting to expedite its resolution [2, 3]. Hemodialysis has been used in patients with severe manifestations of renal failure [4]. More data, however, are needed regarding the most optimal strategy for the removal of the catheters (i.e., removal of both stents together immediately postoperatively or removal in a more graded ‘‘one-by-one’’ fashion 12–24 h apart). Reports about the incidence of reflex anuria with either approach exist in the literature [4].

2

Section of Colorectal Surgery, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA

Conflict of interest

Dear Sir, The utility of prophylactic ureteral catheters in surgical practice remains controversial. Several authors have reported their experience with the placement of prophylactic ureteral stents in open and laparoscopic gynecologic, colorectal and general surgical procedures entailing pelvic dissections [1]. The traditional surgical dogma about such stents has supported their utility in intraoperative identification but not prevention of ureteral injuries [2]. In addition to the added cost and operative time, the use of such catheters can result in complications such as urinary tract infections, hematuria and ureteral trauma. Reflex anuria is a very rare complication of ureteral stent placement, and it has been theorized that it occurs secondary to the development of ureterovesical junction edema due to direct trauma, generalized renal cortical vasoconstriction or ureterorenal reflex, whereby injury to one ureter can cause bilateral or contralateral arteriolar or ureteral spasm [1–4]. A 71-year-old gentleman with multiple medical comorbidities recently came to our attention and was found to have a sigmoid carcinoma on a colonoscopic biopsy. He underwent preoperative cystoscopy with placement of bilateral ureteral stents followed by a laparoscopic-assisted sigmoidectomy and en bloc resection of small bowel with primary anastomosis. His ureteral catheters were removed together within 24 h postoperatively. However, about 16 h

& T. Saleem [email protected]

None.

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Tech Coloproctol

References 1. Kuno K, Menzin A, Kauder HH, Sison C, Gal D (1998) Prophylactic ureteral catheterization in gynecologic surgery. Urology 52:1004–1008 2. Singh K, Saba S, Pekarev M, Zomaya M, Patankar S (2012) Acute renal failure as a complication of preoperative ureter catheterization for colorectal surgery. Nephro-Urol 4:384–387

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3. Singh K, Wang ML, Nakaska M (2011) Reflex anuria. BJU Int 108:793–795 4. Bieniek JM, Meade PG (2012) Reflux anuria after prophylactic ureteral catheter removal: a case description and review of the literature. J Endourol 26:294–296

Reflex anuria: a rare complication of prophylactic ureteral catheterization.

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