PREOPERATIVE URETERAL STENT PLACEMENT IN THE IDENTIFICATION OF INTRAOPERATIVE IDENTIFICATION OF IATROGENIC URETERAL INJURY?

“The use of prophylactic ureteral stents remains controversial and could help in the intraoperative identification of ureteral injury.”

Methods:
Patients undergoing elective abdominal colorectal surgery and preoperative ureteral stent placement at three enterprise-wide tertiary referral hospitals between 2015 and 2021 were retrospectively identified through their billing records. The main study endpoint was ureteral injury identified within 30 days postoperatively. The decision to place ureteral stents was at the discretion of the treating surgeon. A number of demographic, disease-related, and treatment-related variables were examined for possible association with ureteral stent placement. We compared the incidence of ureteral injury and timing of the identification according to use of ureteral stents. Bivariate associations were examined using Kruskal-Wallis tests for continuous variables and Chi-square tests for categorical variables.

Results:
Out of 7925 patients undergoing elective colorectal surgery, 1118 (16.3%) underwent preoperative ureteral stent placement. Use of preoperative ureteral stents was significantly associated with a higher ASA class (53% vs 44% ASA3, p= <0.001), wound classification (28% vs 18% Type III; 15.6% vs 4.8% Type IV, p <0.001), and longer duration of surgery (5.6 vs 3.7 hours, p <0.001). With respect to postoperative complications, use of ureteral stents was associated with significantly increased risk of iatrogenic ureteral injury (1.3% vs 0.2%, p= <0.001), acute kidney injury (14% vs 9%, p<0.001), and UTI (7% vs 3%, p<0.001). Ureteral injury was identified in 32 patients (0.4%). Of these, 15 did not have a stent, and 17 had preoperative stent placement. The ureteral injury was identified intraoperatively in 19/32 (59%) patients. However, use of ureteral stents was not associated with increased intraoperative identification (53% vs 47%, p= 0.43).

Heimberger, Mark, et al. “925: CAN PREOPERATIVE URETERAL STENT PLACEMENT HELP IN THE INTRAOPERATIVE IDENTIFICATION OF IATROGENIC URETERAL INJURY?.” Gastroenterology 162.7 (2022): S-1348. Free Full Text