Can preoperative ureteral stent placement help in the intraoperative identification of iatrogenic ureteral injury?

Abstract

BackgroundThe benefits of prophylactic ureteral stent placement during colorectal surgery remain controversial.The aims of the present study were to determine the incidence of ureteral injury in colorectal operations, assess the complications associated with stent usage, and determine if their use leads to earlier identification and treatment of injury. MethodsRetrospective study of patients undergoing colorectal abdominal operations between 2015 and 2021. Variables were examined for possible association with ureteral stent placement. The primary study endpoint was ureteral injury identified within 30 days postoperatively. ResultsOf 6481 colorectal surgery patients, 970 (15%) underwent preoperative ureteral stent placement. Use of stents was significantly associated with a higher ASA classification, wound classification, and longer duration of surgery. A ureteral injury was identified in 28 patients (0.4%). Of these, 13 had no stent, and 15 had preoperative stents placed. After propensity matching, stent use was associated with increased risk of hematuria and UTI. Ureteral injury was identified intraoperatively in 14/28 (50%) patients and was not associated with ureteral stent use (p=0.45). ConclusionsIatrogenic ureteral injury was uncommon, while preoperative stent placement was relatively frequent. Earlier recognition of iatrogenic ureteral injury is not an expected advantage of preoperative ureteral stent placement.