Intraoperative Ureteral Stent Use at Radical Cystectomy is Associated with Higher 30-Day Complication Rates

Donat, S. Machele; Tan, Kay See; Jibara, Ghalib; Dalbagni, Guido; Carlon, Vittoria Arslan; Sandhu, Jaspreet S.

doi:10.1097/ju.0000000000001329

Cited by 23 publications

(14 citation statements)

References 24 publications

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“…retrospective and hypothesis-generating study reported less postoperative infections among unstented patients, and only one ureterointestinal leak in 77 patients [20].…”

Section: Key Pointsmentioning

confidence: 86%

“…Patients with stents showed earlier return of bowel function after surgery and less frequent postoperative metabolic acidosis, whereas no patients without stent in that study developed an ureteroenteric stricture. Furthermore, a recent retrospective and hypothesis-generating study reported less postoperative infections among unstented patients, and only one ureterointestinal leak in 77 patients [20].…”

Section: Ureterointestinal Insufficiency and Ureterointestinal Stenosismentioning

confidence: 96%

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Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Bobjer

2021

Current Opinion in Urology

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Purpose of reviewUrinary diversion (UD) with or without cystectomy is a procedure with high short term complication rates. In this review, we summarize the most relevant findings of the last 2 years.Recent findingsThe use of a prophylactic mesh decreases the risk of parastomal hernia after ileal conduit (IC) surgery without adding mesh-related complications according to a recent randomized multicentre trial. Robot-assisted surgery is increasingly applied for UD and is evolving from extra- to intra-corporeal reconstruction in both continent and incontinent diversions, but there is still a need for appropriately designed studies assessing both short- and long-term complications. Promising techniques to decrease ureterointestinal stricture rates have been reported from small series, such as retrosigmoid placement of the proximal IC to avoid transpositioning of the left ureter, or in robot-assisted surgery the use of indocyanine green with near-infrared light to improve visualisation of distal ureteral viability.SummaryMost recent reports derive from observational data. Appropriate randomized studies are warranted for the evaluation of new techniques to be implemented in a surgical area that still is associated with high complication rates.

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“…retrospective and hypothesis-generating study reported less postoperative infections among unstented patients, and only one ureterointestinal leak in 77 patients [20].…”

Section: Key Pointsmentioning

confidence: 86%

Section: Ureterointestinal Insufficiency and Ureterointestinal Stenosismentioning

confidence: 96%

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Bobjer

2021

Current Opinion in Urology

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“…In the present study, febrile UTI was identified in 57 patients (14.1%). Donat et al reported that infectious complications were lower in the non-intraoperative stent group than in the intraoperative stent group (14% vs. 32%, p = 0.004) [19], and the risk of bacteremia and UTI increased approximately one day after stent removal [18]. Possible explanations for the increase in UTI after stent removal include bacterial colonization, stent obstruction from mucus, and urinary reflux caused by the stent.…”

Section: Discussionmentioning

confidence: 99%

“…However, the evidence for the benefits of intraoperative ureteral stent insertion is insufficient; several studies have reported no correlation between ureteral stent insertion and UIAS [15][16][17]. Moreover, other studies have suggested that ureteral stent insertion increases the risk of infectious complications by acting as a source of infection [18,19].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Stentless Uretero-Intestinal Anastomosis in Radical Cystectomy with Ileal Orthotopic Neobladder

Lee

et al. 2021

JCM

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Background: We evaluated the feasibility and safety of stentless uretero-intestinal anastomosis (UIA) during radical cystectomy (RC) with an ileal orthotopic neobladder. Methods: We retrospectively reviewed 403 patients who underwent RC for bladder cancer between August 2014 and December 2018. The primary objective was to study the effect of stentless UIA on uretero-intestinal anastomosis stricture (UIAS), and the secondary objective was to evaluate the association between stentless UIA and other complications, including paralytic ileus, febrile urinary tract infection (UTI), and urine leakage. Kaplan–Meier survival analysis was used to estimate UIAS-free survival, and Cox proportional hazard models were applied to identify factors associated with the risk of UIAS. Results: Among 403 patients with 790 renal units, UIAS was identified in 39 (9.7%) patients and 53 (6.7%) renal units. Forty-four (83.0%) patients with UIAS were diagnosed within 6 months. The 1- and 2-year overall UIAS-free rates were 93.9% and 92.7%, respectively. Paralytic ileus was identified in 105 (26.1%) patients and resolved with supportive treatment. Febrile UTI occurred in 57 patients (14.1%). However, there was no leak of the UIA. Conclusions: Stentless UIA during RC with an ileal orthotopic neobladder is a feasible and safe surgical option. Further prospective randomized trials are required to determine the clinical usefulness of stentless UIA during RC.

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“…After long‐term stent implantation, patients sometimes forget that stents have been implanted in their bodies. The surface properties of the material can change after long‐term indwelling, leading to dysuria, infection, and even patient death 16,17 …”

Section: Introductionmentioning

confidence: 99%

Preparing and characterizing biodegradable materials for ureteral stents

Cui

Zhang

Gao³

et al. 2021

Polymers for Advanced Techs

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The development and application of biodegradable ureteral stents is of clinical significance for patients with ureteral stenosis and obstruction. We prepared five types of degradable monofilament, namely poly‐L‐lactide, poly(L‐lactide‐co‐ glycolide) (85% L‐lactide, 15% glycolide), poly(L‐lactide‐co‐glycolide‐co‐ε‐ caprolactone) (89% L‐lactide, 8% glycolide, and 3% ε‐caprolactone), poly(L‐lactide‐ co‐D,L‐lactide) (95% L‐lactide, 5% D,L‐lactide), and poly(lactide‐co‐ε‐caprolactone) (95% L‐lactide, 5% ε‐caprolactone), by melt extrusion and secondary drawing processes, after which degradation experiments were carried out in simulated urine at 37°C for 2 months. Because residues in the urinary systems of patients can cause complications, it is important that biodegradable ureteral stents are completely degraded after 6 weeks. Poly‐L‐lactide did not completely degrade under the abovementioned conditions and its molecular weight changed little. On the other hand, the poly(L‐lactide‐co‐glycolide) monofilament degraded slightly faster than that prepared from poly‐L‐lactide; however it maintained a certain mechanical strength after 8 weeks, which is not ideal for a woven ureteral stent. The poly(L‐lactide‐co‐D,L‐lactide), poly(L‐lactide‐co‐glycolide‐co‐ε‐caprolactone), and poly(lactide‐co‐ε‐caprolactone) monofilaments exhibited good tensile strengths and elongations at break in the first four weeks, which were reduced to almost zero in the eighth week. Ureteral stents made of these polymers can open narrow urethras at early stages and degrade completely at later stages. Based on its degradation rate, we conclude that the poly(lactide‐co‐ε‐caprolactone) monofilament is the best material for the preparation of ureteral stents.

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Intraoperative Ureteral Stent Use at Radical Cystectomy is Associated with Higher 30-Day Complication Rates

Cited by 23 publications

References 24 publications

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Feasibility and Safety of Stentless Uretero-Intestinal Anastomosis in Radical Cystectomy with Ileal Orthotopic Neobladder

Preparing and characterizing biodegradable materials for ureteral stents

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