2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery

de'Angelis, Nicola;Schena, Carlo Alberto;Marchegiani, Francesco;Reitano, Elisa;De Simone, Belinda;Wong, Geoffrey Yuet Mun;Martínez-Pérez, Aleix;Abu-Zidan, Fikri M;Agnoletti, Vanni;Aisoni, Filippo;Ammendola, Michele;Ansaloni, Luca;Bala, Miklosh;Biffl, Walter;Ceccarelli, Graziano;Ceresoli, Marco;Chiara, Osvaldo;Chiarugi, Massimo;Cimbanassi, Stefania;Coccolini, Federico;Coimbra, Raul;Di Saverio, Salomone;Diana, Michele;Dioguardi Burgio, Marco;Fraga, Gustavo;Gavriilidis, Paschalis;Gurrado, Angela;Inchingolo, Riccardo;Ingels, Alexandre;Ivatury, Rao;Kashuk, Jeffry L;Khan, Jim;Kirkpatrick, Andrew W;Kim, Fernando J;Kluger, Yoram;Lakkis, Zaher;Leppäniemi, Ari;Maier, Ronald V;Memeo, Riccardo;Moore, Ernest E;Ordoñez, Carlos A;Peitzman, Andrew B;Pellino, Gianluca;Picetti, Edoardo;Pikoulis, Manos;Pisano, Michele;Podda, Mauro;Romeo, Oreste;Rosa, Fausto;Tan, Edward;Ten Broek, Richard P;Testini, Mario;Tian Wei Cheng, Brian Anthony;Weber, Dieter;Sacco, Emilio;Sartelli, Massimo;Tonsi, Alfredo;Dal Moro, Fabrizio;Catena, Fausto

2023-01-01

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Abstract

Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.