Top

International Journal of Colorectal Disease

Published in:

01-07-2019 | Review

The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections

Authors: Stefanie M. Croghan, Alexandra Zaborowski, Helen M. Mohan, David Mulvin, Barry B. McGuire, Michael Murphy, David J. Galvin, Gerry Lennon, David Quinlan, Des C. Winter

Published in: International Journal of Colorectal Disease | Issue 7/2019

Abstract

Purpose

‘Prophylactic’ ureteric stents potentially reduce rates, and facilitate intraoperative recognition, of iatrogenic ureteric injury (IUI) during colorectal resections. A lack of consensus surrounds the risk–benefit equation of this practice, and we aimed to assess the evidence base.

Methods

A systematic review was performed according to PRISMA guidelines. MEDLINE, Scopus, EMBASE and Cochrane databases were searched using terms ‘ureteric/ureteral/JJ/Double J stent’ or ‘ureteric/ureteral catheter’ and ‘colorectal/prophylactic/resection/diverticular disease/diverticulitis/iatrogenic injury’. Primary outcomes were rates of ureteric injuries and their intraoperative identification. Secondary outcomes included stent complication rates.

Results

We identified 987 publications; 22 papers met the inclusion criteria. No randomised controlled trials were found. The total number of patients pooled for evaluation was 869,603 (102,370 with ureteric stents/catheters, 767,233 controls). The most frequent indications for prophylactic stents were diverticular disease (45.38%), neoplasia (33.45%) and inflammatory bowel disease (9.37%). Pooled results saw IUI in 1521/102,370 (1.49%) with, and in 1333/767,233 (0.17%) without, prophylactic ureteric stents. Intraoperative recognition of IUIs occurred in 10/16 injuries (62.5%) with prophylactic stents, versus 9/17 (52.94%) without stents (p = 0.579). The most serious complications of prophylactic stent use were ureteric injury (2/1716, 0.12%) and transient ureteric obstruction following stent removal (13/666, 1.95%).

Conclusions

Placement of prophylactic ureteric stents has a low complication rate. There is insufficient evidence to conclude that stents decrease ureteric injury or increase intraoperative detection of IUIs. Apparently higher rates of IUI in stented patients likely reflect use in higher risk resections. A prospective registry with harmonised data collection points and stratification of intraoperative risk is needed.

Available only for authorised users

Abboudi H, Ahmed K, Royle J, Khan MS, Dasgupta P, N'Dow J (2013) Ureteric injury: a challenging condition to diagnose and manage. Nat Rev Urol 10(2):108–115. https://doi.org/10.1038/nrurol.2012.254 CrossRefPubMed

Halabi WJ, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ (2014) Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum 57(2):179–186. https://doi.org/10.1097/DCR.0000000000000033 CrossRefPubMed

Coakley KM, Kasten KR, Sims SM, Prasad T, Heniford BT, Davis BR (2018) Prophylactic ureteral catheters for colectomy: a national surgical quality improvement program-based analysis. Dis Colon Rectum 61(1):84–88. https://doi.org/10.1097/dcr.0000000000000976 CrossRefPubMed

Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, Rafferty JF (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294. https://doi.org/10.1097/DCR.0000000000000075 CrossRefPubMed

Andersen P, Andersen LM, Iversen LH (2015) Iatrogenic ureteral injury in colorectal cancer surgery: a nationwide study comparing laparoscopic and open approaches. Surg Endosc 29(6):1406–1412. https://doi.org/10.1007/s00464-014-3814-1 CrossRefPubMed

Masoomi H, Buchberg B, Nguyen B, Tung V, Stamos MJ, Mills S (2011) Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis. World J Surg 35(9):2143–2148. https://doi.org/10.1007/s00268-011-1117-4 CrossRefPubMed

Guller U, Rosella L, Karanicolas PJ, Adamina M, Hahnloser D (2010) Population-based trend analysis of 2813 patients undergoing laparoscopic sigmoid resection. Br J Surg 97(1):79–85. https://doi.org/10.1002/bjs.6787 CrossRefPubMed

Chiu AS, Jean RA, Gorecka J, Davis KA, Pei KY (2017) Trends of ureteral stent usage in surgery for diverticulitis. J Surg Res 222:203–211.e3. https://doi.org/10.1016/j.jss.2017.09.050 CrossRefPubMed

Selzman AA, Spirnak JP (1996) Iatrogenic ureteral injuries: a 20-year experience in treating 165 injuries. J Urol 155(3):878–881CrossRefPubMed

10.

Mahendran HA, Praveen S, Ho C, Goh EH, Tan GH, Zuklifli MZ (2012) Iatrogenic ureter injuries: eleven years experience in a tertiary hospital. Med J Malaysia 67(2):169–172PubMed

11.

Parpala-Sparman T, Paananen I, Santala M, Ohtonen P, Hellstrom P (2008) Increasing numbers of ureteric injuries after the introduction of laparoscopic surgery. Scand J Urol Nephrol 42(5):422–427. https://doi.org/10.1080/00365590802025857 CrossRefPubMed

12.

Delacroix SE Jr, Winters JC (2010) Urinary tract injures: recognition and management. Clin Colon Rectal Surg 23(2):104–112. https://doi.org/10.1055/s-0030-1254297 CrossRefPubMedPubMedCentral

13.

Mulholland M, Doherty G (2006) Complications in surgery. In: Complications in surgery. Lippincott Williams & Wilkins, PhiladelphiaCrossRef

14.

Althumairi AA, Efron JE (2016) Genitourinary considerations in reoperative and complex colorectal surgery. Clinics in Colon and Rectal Surgery 29(2):145–151. https://doi.org/10.1055/s-0036-1580629 CrossRefPubMedPubMedCentral

15.

Brandes S, Coburn M, Armenakas N, McAninch J (2004) Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 94(3):277–289. https://doi.org/10.1111/j.1464-410X.2004.04978.x CrossRefPubMed

16.

El Abd AS, El-Abd SA, El-Enen MA, Tawfik AM, Soliman MG, Abo-Farha M, Gamasy AE, El-Sharaby M, El-Gamal S (2015) Immediate and late management of iatrogenic ureteric injuries: 28 years of experience. Arab J Urol 13(4):250–257. https://doi.org/10.1016/j.aju.2015.07.004 CrossRefPubMedPubMedCentral

17.

Serafetinides E, Kitrey ND, Djakovic N, Kuehhas FE, Lumen N, Sharma DM, Summerton DJ (2015) Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel. Eur Urol 67(5):930–936. https://doi.org/10.1016/j.eururo.2014.12.034 CrossRefPubMed

18.

Leff EI, Groff W, Rubin RJ, Eisenstat TE, Salvati EP (1982) Use of ureteral catheters in colonic and rectal surgery. Dis Colon Rectum 25(5):457–460CrossRefPubMed

19.

Remington JH (1959) Prevention of ureteral injury in surgery of the pelvic colon. Dis Colon Rectum 2(4):340–349CrossRefPubMed

20.

Summerton D, Djakovic N, Kitrey N, Kuehhas F, Lumen N, Serafetinidis E, Sharma D (2014) Guidelines on urological trauma. European Association of Urology, Arnhem

21.

Croghan S, Zaborowski A, Mohan H, Winter D, Quinaln D (2018) A systematic review of the benefits and/or risks of planned ureteric stenting prior to colorectal surgery. PROSPERO International Database

22.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535 CrossRefPubMedPubMedCentral

23.

Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384CrossRefPubMedPubMedCentral

24.

Mohan H, Nicholson P, Winter DC, O'Shea D, O’Toole D, Geoghegan J, Maguire D, Hoti E, Traynor O, Cantwell CP (2015) Radiofrequency ablation for neuroendocrine liver metastases: a systematic review. J Vasc Interv Radiol 26(7):935–942 e931. https://doi.org/10.1016/j.jvir.2014.12.009 CrossRefPubMed

25.

Deeks JJ, Higgins JPT, Altman DG (2008) Chapter 9: analysing data and undertaking meta‐analyses. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions: cochrane book series. John Wiley & Sons, Chichester. https://doi.org/10.1002/9780470712184.ch9

26.

Nam YS, Wexner SD (2002) Clinical value of prophylactic ureteral stent indwelling during laparoscopic colorectal surgery. J Korean Med Sci 17(5):633–635. https://doi.org/10.3346/jkms.2002.17.5.633 CrossRefPubMedPubMedCentral

27.

Merola J, Arnold B, Luks V, Ibarra C, Resio B, Davis KA, Pei KY (2017) Prophylactic ureteral stent placement vs no ureteral stent placement during open colectomy. JAMA surgery 153:87–90. https://doi.org/10.1001/jamasurg.2017.3477 CrossRefPubMedCentral

28.

Chong JT, Kan KM, Phillips CK, Greenstein A (2018) Ureteral catheters for colorectal surgery: influence on operative times and complication outcomes: an observational study. Investig Clin Urol 59(2):119–125. https://doi.org/10.4111/icu.2018.59.2.119 CrossRefPubMedPubMedCentral

29.

Pokala N, Delaney CP, Kiran RP, Bast J, Angermeier K, Fazio VW (2007) A randomized controlled trial comparing simultaneous intra-operative vs sequential prophylactic ureteric catheter insertion in re-operative and complicated colorectal surgery. Int J Color Dis 22(6):683–687. https://doi.org/10.1007/s00384-006-0219-1 CrossRef

30.

Speicher PJ, Goldsmith ZG, Nussbaum DP, Turley RS, Peterson AC, Mantyh CR (2014) Ureteral stenting in laparoscopic colorectal surgery. J Surg Res 190(1):98–103. https://doi.org/10.1016/j.jss.2014.02.025 CrossRefPubMed

31.

Beraldo S, Neubeck K, Von Friderici E, Steinmuller L (2013) The prophylactic use of a ureteral stent in laparoscopic colorectal surgery. Scand J Surg 102(2):87–89. https://doi.org/10.1177/1457496913482247 CrossRefPubMed

32.

Kyzer S, Gordon PH (1994) The prophylactic use of ureteral catheters during colorectal operations. Am Surg 60(3):212–216PubMed

33.

Boyan WP Jr, Lavy D, Dinallo A, Otero J, Roding A, Hanos D, Dressner R, Arvanitis M (2017) Lighted ureteral stents in laparoscopic colorectal surgery; a five-year experience. Ann Transl Med 5(3):44. https://doi.org/10.21037/atm.2017.02.01 CrossRefPubMedPubMedCentral

34.

Chahin F, Dwivedi AJ, Paramesh A, Chau W, Agrawal S, Chahin C, Kumar A, Tootla A, Tootla F, Silva YJ (2002) The implications of lighted ureteral stenting in laparoscopic colectomy. J Soc Laparoendos Surg 6(1):49–52

35.

Senagore AJ, Luchtefeld M (1994) An initial experience with lighted ureteral catheters during laparoscopic colectomy. J Laparoendosc Surg 4(6):399–403CrossRefPubMed

36.

Tsujinaka S, Wexner SD, DaSilva G, Sands DR, Weiss EG, Nogueras JJ, Efron J, Vernava Iii AM (2008) Prophylactic ureteric catheters in laparoscopic colorectal surgery. Tech Coloproctol 12(1):45–50. https://doi.org/10.1007/s10151-008-0397-7 CrossRefPubMed

37.

Hassinger TE, Mehaffey JH, Mullen MG, Michaels AD, Elwood NR, Levi ST, Hedrick TL, Friel CM (2018) Ureteral stents increase risk of postoperative acute kidney injury following colorectal surgery. Surg Endosc 32(7):3342–3348. https://doi.org/10.1007/s00464-018-6054-y CrossRefPubMed

38.

Luks VL, Merola J, Arnold BN, Ibarra C, Pei KY (2018) Prophylactic ureteral stenting in laparoscopic colectomy: revisiting traditional practice. J Surg Res 234:161–166CrossRefPubMed

39.

Sahoo MR, Anil Kumar T (2012) Prophylactic ureteric catheterization with illuminated ureteric stent during difficult laparoscopic colorectal surgeries. World J Lap Surg 5(3):113–115. https://doi.org/10.5005/jp-journals-10033-1161 CrossRef

40.

Bothwell WN, Bleicher RJ, Dent TL (1994) Prophylactic ureteral catheterization in colon surgery. A five-year review. Dis Colon Rectum 37(4):330–334CrossRefPubMed

41.

Pathak RA, Taylor AS, Alford S, Broderick GA, Igel TC, Petrou SP, Wehle MJ, Young PR, Thiel DD (2015) Urologic-induced complications of prophylactic ureteral localization stent placement for colorectal surgery cases. J Laparoendosc Adv Surg Tech A 25(12):966–970. https://doi.org/10.1089/lap.2015.0345 CrossRefPubMed

42.

Sheikh FA, Khubchandani IT (1990) Prophylactic ureteric catheters in colon surgery--how safe are they? Report of three cases. Dis Colon Rectum 33(6):508–510CrossRefPubMed

43.

Kutiyanawala S, Jameson (1999) Ureteric injuries during colorectal surgery: strategies for prevention. Color Dis 1(6):334–337. https://doi.org/10.1046/j.1463-1318.1999.00087.x CrossRef

44.

Palaniappa NC, Telem DA, Ranasinghe NE, Divino CM (2012) Incidence of iatrogenic ureteral injury after laparoscopic colectomy. Arch Surg 147(3):267–271. https://doi.org/10.1001/archsurg.2011.2029 CrossRefPubMed

45.

Williams Vs. Surgical Associates (2018) Prince George's County, Maryland. https://www.millerandzois.com/ureteral-trauma-colon-surgerylawsuit.html. Accessed 03 Mar 19

46.

Douissard J, Ris F, Morel P, Buchs NC (2018) Current strategies to prevent iatrogenic ureteral injury during colorectal surgery. Surg Technol Int 32:119–124PubMed

47.

Sheka AC, Tevis S, Kennedy GD (2016) Urinary tract infection after surgery for colorectal malignancy: risk factors and complications. Am J Surg 211(1):31–39. https://doi.org/10.1016/j.amjsurg.2015.06.006 CrossRefPubMed

48.

Nagle D, Curran T, Anez-Bustillos L, Poylin V (2014) Reducing urinary tract infections in colon and rectal surgery. Dis Colon Rectum 57(1):91–97. https://doi.org/10.1097/DCR.0000000000000019 CrossRefPubMed

49.

O'Connor ME, Kirwan CJ, Pearse RM, Prowle JR (2016) Incidence and associations of acute kidney injury after major abdominal surgery. Intensive Care Med 42(4):521–530. https://doi.org/10.1007/s00134-015-4157-7 CrossRefPubMed

50.

Hull JD, Kumar S, Pletka PG (1980) Reflex anuria from unilateral ureteral obstruction. J Urol 123(2):265–266CrossRefPubMed

51.

Teichman JM, Lackner JE, Harrison JM (1997) Comparison of lighted ureteral catheter luminance for laparoscopy. Tech Urol 3(4):213–215PubMed

52.

Korb ML, Huh WK, Boone JD, Warram JM, Chung TK, de Boer E, Bland KI, Rosenthal EL (2015) Laparoscopic fluorescent visualization of the ureter with intravenous IRDye800CW. J Minim Invasive Gynecol 22(5):799–806. https://doi.org/10.1016/j.jmig.2015.03.008 CrossRefPubMedPubMedCentral

53.

Dip FD, Nahmod M, Anzorena FS, Moreira A, Sarotto L, Ampudia C, Kalaskar SN, Ferraina P, Rosenthal RJ, Wexner SD (2014) Novel technique for identification of ureters using sodium fluorescein. Surg Endosc Other Interv Tech 28(9):2730–2733. https://doi.org/10.1007/s00464-014-3519-5 CrossRef

54.

Yeung TM, Volpi D, Tullis IDC, Nicholson GA, Buchs N, Cunningham C, Guy R, Lindsey I, George B, Jones O, Wang LM, Hompes R, Vojnovic B, Hamdy F, Mortensen NJ (2016) Identifying ureters in situ under fluorescence during laparoscopic and open colorectal surgery. Ann Surg 263(1):e1–e2. https://doi.org/10.1097/SLA.0000000000001513 CrossRefPubMed

55.

Al-Taher M, van den Bos J, Schols RM, Bouvy ND, Stassen LP (2016) Fluorescence ureteral visualization in human laparoscopic colorectal surgery using methylene blue. J Laparoendos Adv Surg Tech A 26(11):870–875. https://doi.org/10.1089/lap.2016.0264 CrossRef

Title: The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections
Authors: Stefanie M. Croghan
Alexandra Zaborowski
Helen M. Mohan
David Mulvin
Barry B. McGuire
Michael Murphy
David J. Galvin
Gerry Lennon
David Quinlan
Des C. Winter
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 7/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03314-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2019

Prognostic impact of the combination of neutrophil-to-lymphocyte ratio and Glasgow prognostic score in colorectal cancer: a retrospective cohort study

High prevalence of hidradenitis suppurativa in patients with perianal fistula

Omental flaps in patients undergoing abdominoperineal resection for rectal cancer

Improving treatment of patients with inflammatory bowel diseases: a controlled trial of a multifaceted intervention in two German cities

Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery—a national population-based cohort study

Hybrid minimally invasive/open approach versus total minimally invasive approach for rectal cancer resection: short- and long-term results