Urinary Tract Injuries in Abdominal, Laparoscopic and Robotic Surgery: a Comprehensive Review.

Background/aim: Urinary tract injuries (UTIs) are a significant complication in abdominal, laparoscopic and robotic surgeries. Due to the proximity of the urinary tract to critical structures, procedures like colorectal surgery, hysterectomy and prostatectomy pose risks. Minimally invasive techniques like laparoscopy and robotic surgery offer benefits but introduce unique challenges. This review explores the incidence, risk factors and management strategies for UTIs across surgical approaches.

Materials and methods: A systematic review of PubMed, Embase and Web of Science was conducted. Studies on abdominal, gynecological, and urological surgeries reporting UTIs were included. After screening, 17 studies published between 1990 and 2024 were analyzed. The PRISMA method was used for selection and data extraction.

Results: The incidence of UTI varies by surgery type: for open surgery, higher rates (0.5%-3.0%) were recorded due to invasive techniques and longer operative times, particularly in colorectal surgeries and hysterectomies. In laparoscopic surgery, a lower incidence (0.1%-1.0%) was noted, though thermal injury and visualization challenges remain. Finally, in robotic surgery, incidence ranges from 0.2% to 1.5%, with enhanced precision reducing the risk of UTIs in complex surgeries like prostatectomy and hysterectomy.

Conclusion: The primary causes of UTIs include direct trauma, thermal injury and postoperative ischemia. Advanced technologies like robotic systems and intraoperative imaging reduce risks but require surgeon expertise. Preventing UTIs in surgery involves meticulous planning, advanced intraoperative technologies and comprehensive postoperative care. Continued research into minimally invasive techniques will further reduce complication rates and improve patient outcomes.