Does prophylactic ureteral catheter placement offer any advantage for laparoscopic gynecological surgery? A urologist’ perspective from a systematic review and meta-analysis

Our aim is to assess the efficacy of prophylactic ureteral catheter placement on patients undergoing laparoscopic gynecological surgery. We searched the electronic database including PubMed, Cochrane Library, Embase, Web of Science, WANFANG and CNKI in January 2020 to identify possible studies without languages limitations. A manual search was also conducted. The trials that compared catheterized group (CG) to non-catheterized group (NCG) were included. This meta-analysis was accomplished by RevMan5 (version 5.3). Initial search yield 997 studies and 5 randomized control trials were included in the final meta-analysis. Pooling data of five studies showed that patients in the CG had a lower risk of ureteral injury than those in NCG (RR: 0.44, 95% CI: 0.20–0.97, P=0.04) without significant between-study heterogeneity (P=0.23, I(2)=29%). The pooled data analysis showed a statistically significant difference in favor of prophylactic ureter catheter placement (MD: −40.51, 95% CI: −58.65 to −22.36, P<0.0001). Random-effects model meta-analysis found that patients in the CG experienced higher EBL compared to NCG (SMD: −5.78, 95% CI: −10.51 to −1.04, P=0.02). There was no statistically significant difference between CG group and NCG group (P=0.23) with regard to LOS. Current evidence indicates that prophylactic ureteral catheter placement has the advantages of reducing ureteral injury, shortening the operative time, and reducing the amount of bleeding. It might serve as a routine preoperative preparation choice for laparoscopic gynecological surgery, especially with pelvic adhesion. Further large volume, multicenter well-designed trials are warranted before making the final clinical guidelines.