Iatrogenic Ureteral Injury and Prophylactic Stent Use in Veterans Undergoing Colorectal Surgery

Shahait, Awni D; Mesquita-Neto, Jose Wilson; Girten, Kara; Weaver, Donald W.; Gruber, Scott A.; Ghorbani, Mostafa

doi:10.1016/j.jss.2021.03.054

Cited by 10 publications

(17 citation statements)

References 26 publications

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“…A total of 2874 articles were excluded after screening the titles and abstracts, and a full‐text review was performed for 250 articles. According to our inclusion criteria, we finally identified 46 studies for this meta‐analysis [3,8–10,12,18–57], comprising 1719 ureteric injuries, 491 519 patients eligible for incidence analysis, and 3106 ureteric injuries eligible for treatment outcome analysis. The demographics of each included study are shown in Tables S2–S5.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 19 studies were included for the analyses [8–10,12,33–44,55–57]. Demographics of included studies and the results of ureteric injuries are shown in Table 1, Tables S3 and S4 [8–10,12,33–44,55–57].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 19 studies were included for the analyses [8][9][10]12,[33][34][35][36][37][38][39][40][41][42][43][44][55][56][57]. Demographics of included studies and the results of ureteric injuries are shown in Table 1, Tables S3 and S4 [8][9][10]12,[33][34][35][36][37][38][39][40][41][42][43][44][55][56][57].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…This has led to pre-emptive steps, such as placement of ureteric stents, to make identifying the ureter easier. Prophylactic ureteric stenting has been widely adopted to help the intraoperative identification of the ureter with the potential of preventing ureteric injuries [8][9][10]. In addition, prophylactic ureteric stenting could aid in the early intraoperative identification of a ureteric injury.…”

Section: Introductionmentioning

confidence: 99%

“…Ureteric stenting is also thought to be helpful, particularly during laparoscopic surgery, by facilitating the tactile identification of the ureter [11]. However, most of these reported advantages are based on rare incidences and poorly designed or small cohort studies [8,12]. Thus, the decision to use ureteric stents tends to be based primarily on the surgeon's perspective/wishes in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta‐analysis

et al. 2022

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To assess the incidence of ureteric injuries, clinical value of prophylactic ureteric stenting and impact of intra-or postoperative detection of ureteric injuries in patients treated with gynaecological or colorectal surgery. MethodsMultiple databases were searched for articles published before September 2021 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Studies were deemed eligible if they evaluated the differences in the rate of ureteric injuries between laparoscopic and open surgery, prophylactic ureteric stenting or not, and those of final treatment success between intra-and postoperative detection in patients who underwent gynaecological or colorectal surgery. ResultsOverall, 46 studies were eligible for this meta-analysis. Compared to open surgery, laparoscopic hysterectomy was associated with a higher incidence of ureteric injuries (pooled odds ratio [OR] 2.12, 95% confidence interval [CI] 1.71-2.62), but there was no statistically significant difference in colectomy (pooled OR 0.89, 95% CI 0.77-1.03). Prophylactic ureteric stenting was associated with a lower incidence of ureteric injuries during gynaecological surgery (pooled OR 0.61, 95% CI 0.39-0.96). The number needed to perform ureteric stenting to prevent one ureteric injury was 224 in gynaecological surgery. On the other hand, prophylactic ureteric stenting did not reduce the risk of ureteric injuries during colorectal surgery. Intraoperative detection of a ureteric injury was associated with a lower rate of complication management failure compared to postoperative detection (pooled OR 0.22, 95% CI 0.12-0.41). ConclusionsLaparoscopic hysterectomy seems to be associated with a higher rate of ureteric injuries compared to an open approach. Prophylactic ureteric stenting seems to reduce this risk during gynaecological surgery. Intraoperative detection of a ureteric injury during abdominal/pelvic surgery improves outcomes, suggesting the need for awareness and proactive problem identification. Further well-designed studies assessing the candidates who are more likely to benefit from prophylactic ureteric stenting including cost analysis are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta‐analysis

et al. 2022

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Risk stratification of acute kidney injury (AKI) following ureteral stent insertion for colorectal surgery

Matkov,

Curry,

Ochoa

2023

Surg Endosc

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Acute kidney injury after colorectal surgery with prophylactic ureteral stents

Rather,

Fisher,

Gardner

et al. 2024

Surg Endosc

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Background After colorectal surgery, acute kidney injury (AKI) results from a complex interplay of multiple independent causes and preventive measures that occur during the hospitalization. Prophylactic stenting for ureter identification has been identified as a potential cause, but the evidence is conflicting, possibly because of differing baseline characteristics and procedure-related approaches. Objective This retrospective cohort study assesses the role of stents in the etiology of AKI after determining the independent predictors of AKI. Methods From a population of 1224 consecutive colorectal patients (from 8/1/2016 through 12/31/2021), 382 (31.2%) received ureteral stents, and propensity score matching was used to create stented and control groups. Emergent cases and patients with sepsis were excluded from the analysis. Previously identified independent predictors of AKI, minimally invasive procedures, and a history of diabetes mellitus were used as criteria to create two balanced groups. Results Baseline demographic characteristics and procedure-related factors baseline factors were similar between the groups. There was no difference in the rate of AKI between stented patients and controls (P = 0.82), nor was there any difference in postoperative complications, such as chronic renal insufficiency (CRI, P = 0.49), average postoperative creatinine (P = 0.67), urinary tract infections (UTI, P = 0.82), any postoperative infection (P = 0.48), in-hospital complications (P = 1.00), length of stay (LOS, P = 0.15), and 30-day readmissions (P = 0.79). Conclusions In a population of patients where stenting was frequently employed, ureter stents placed for identification did not appear to cause AKI or AKI-related complications. Graphical Abstract

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Iatrogenic Ureteral Injury and Prophylactic Stent Use in Veterans Undergoing Colorectal Surgery

Cited by 10 publications

References 26 publications

Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta‐analysis

Iatrogenic ureteric injury during abdominal or pelvic surgery: a meta‐analysis

Risk stratification of acute kidney injury (AKI) following ureteral stent insertion for colorectal surgery

Acute kidney injury after colorectal surgery with prophylactic ureteral stents

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