Oliguria after prophylactic ureteric stenting in gynaecological surgery—a report of three cases and review of the literature

Abstract

Ureteric injury is one of the most serious complications of gynaecological surgery. Use of prophylactic preoperative bilateral ureteric stents to reduce ureteric injury is established in colorectal surgery and becoming commonplace in complex gynaecological surgery. The safety of the procedure has been questioned due to reports of stent-induced complications including a rare but serious phenomenon of stent-induced transient obstructive oligo-anuria termed reflex anuria, a response to manipulation and irritation of the ureters. A retrospective case-note review of patients who had bilateral ureteric stents placed prior to gynaecological surgery at Salford Royal Hospital, UK, from 2007 to 2011 was performed to identify cases of oligo-anuria post-stenting, which were not related to hypovolaemia, nephrotoxic drugs or a radiologically evident obstruction. All patients had their stents removed immediately at the end of surgery before leaving the operating theatre. Three out of 439 patients (0.7 %), who had preoperative bilateral ureteric stents, developed post-operative oligo-anuria despite relatively normal radiological assessment. In these three cases outlined below, one self-resolved, and two required urgent re-stenting to relieve obstruction. Use of ureteric stents for major gynaecological surgery can expedite intraoperative identification of the ureters to help reduce accidental ureteric injury but can directly cause complications. These three cases have contributed to knowledge of the complications of ureteric stents during major gynaecological surgery. Awareness of reflux anuria as a possible root cause of post-operative acute renal failure is important for guiding appropriate and timely management to preserve renal function.