Introduction: Complex major colorectal surgery carries a significant risk of urological complicatons that may add morbidity and mortality to an already hazardous procedure.  Historical review of urological injury in such cases highlighted the ad-hoc, unplanned nature of urological intervention. At a national centre for complex colorectal surgery, we now minimise urological morbidity by prospectively anticipating urological needs. 

Methods: From April 2015, planned urological interventions were prospectively logged and allocated to a designated urological consultant, and discussed at weekly MDTs as part of planned operating by the colorectal service. We evaluated urological outcomes over the past 6 months with a particular focus on minimising unplanned ureteric injuries. We also estimated the costs of prophylactic ureteric stents compared to unplanned ureteric injury.

Results: In six months, 40 requests were made for urological support for complex salvage colorectal operations.  20 requests were for prophylactic ureteric stent insertions to minimise ureteric injuries.
There were no unplanned ureteric transections in the series, with 5 planned ureteric transections in the stented group due to underlying disease processes. The cost for prophylactic ureteric stent insertion and removal is £1700/case, while the estimated cost of unplanned ureteric injury and subsequent reconstruction is £12000/case.

Conclusions: We did not encounter unexpected ureteric injuries subsequent to the implementation of our advanced planning process for complex colorectal surgery.  The tertiary caseload, with previous multiple operations and radiotherapy, presents a challenging cohort with a higher rate of urological morbidity.  Careful planning enables the at-risk group to be identified permitting timely urological intervention.