Cystoscopy and Placement of Ureteral Stents: Preoperative for HIPEC Surgery

Abstract

Cytoreductive debulking surgeries can be complicated by difficulty identifying the course of the ureters in the retroperitoneum due to exacerbation by any anatomical distortion from tumor burden or history of previous intra-abdominal operations. Inadvertent direct injury to or devascularization of the ureters or the rest of the lower urinary system during the course of these procedures is a serious concern and can result in increased morbidity for the patient. In order to reduce these risks, urologists often prophylactically place ureteral stents in patients preoperatively in order to aid surgical oncologists in readily identifying the course of the ureters during surgery. Here we present the prophylactic ureteral stenting of a patient undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy for extensive appendiceal adenocarcinoma metastasis. We outline the proper cystoscopic technique, identification of the ureteral orifices, stent placement, bladder inspection, and how to secure the stents with the Foley catheter. The stents were placed without incident and without encountering any resistance, suggesting the ureters were not heavily involved with the tumor. Inspection of the bladder revealed no unusual indentation, extrinsic pressure, masses, or other pathology.