Preservation of the mesureter to reduce urinary complications: analysis of data from the observational Leipzig School MMR study.

Wolf, Benjamin; Espig, Oliver; Stolzenburg, Jens-Uwe; Horn, Lars-Christian; Aktas, Bahriye; Höckel, Michael

OBJECTIVE To evaluate the feasibility and effect of mesureteral preservation on urinary complications in the context of total mesometrial resection (TMMR), a surgical treatment for cervical cancer. DESIGN Retrospective cohort study with historic control. SETTING Single tertiary academic center. POPULATION Women older than 18 with primary cervical cancer staged FIGO IB1 - IIB enrolled in the prospective Leipzig School MMR study who underwent total mesometrial resection (TMMR) without adjuvant radiation. METHOD We retrospectively analyzed 100 consecutive TMMR procedures which were performed for cancer of the uterine cervix and in which the mesureter was preserved (intervention group, 01/2014 - 06/2017). We compared this group to the previous 100 consecutive TMMRs which were performed before the introduction of mesureteral preservation (control group, 09/2010-01/2014). MAIN OUTCOME MEASURE The occurrence of urological and specifically ureteral complications. RESULTS Mesureteral preservation was feasible and was associated with a significant decrease in ureteral complications (11% without mesureteral preservation vs. 3% with mesureteral preservation, p=0.049). Furthermore, we found a significant decrease in the number of postoperative percutaneous nephrostomies and re-operations (7% vs. none, p=0.014). There was also a trend towards a decrease in other urinary complications such as postoperative bladder atony and uretero-vaginal fistulas. CONCLUSION The mesureter constitutes a convenient dissection plane enabling the preservation of lateral ureteral blood supply during TMMR. In our study, maintenance of mesureteral integrity was associated with a significant reduction in ureteral complications. Mesureteral preservation might also be useful in other types of pelvic surgeries with a high risk of ureteral damage.