Prophylactic Ureteral Stent Placement vs No Ureteral Stent Placement During Open Colectomy | Colorectal Surgery | JAMA Surgery | JAMA Network
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Research Letter
Association of VA Surgeons
January 2018

Prophylactic Ureteral Stent Placement vs No Ureteral Stent Placement During Open Colectomy

Author Affiliations
  • 1Department of Surgery, Yale School of Medicine, New Haven, Connecticut
JAMA Surg. 2018;153(1):87-90. doi:10.1001/jamasurg.2017.3477

The prophylactic placement of ureteral stents during colorectal surgery may facilitate ureteral identification and/or recognition of injury.1,2 However, reports have cautioned against routine use of ureteral stents owing to the potential of iatrogenic injury during insertion and postoperative complications, including stenosis and infection.3,4 At present, no evidence-based guidelines exist regarding indications for ureteral stenting during colorectal surgery. This cohort study compares the outcomes of open colectomy with ureteral stenting with the outcomes of open colectomy without ureteral stenting.

A cohort of 374 consecutive patients who underwent open colectomy at a tertiary care center between January 1, 2011, and September 30, 2016, was evaluated. Demographic and laboratory data and data on comorbidities, procedural indications, and operative details were collected. Patients with a planned ureteral resection to achieve a negative oncologic margin were excluded (n = 3). The Charlson comorbidity index with age adjustment, a validated measure of perioperative mortality, was calculated and used for risk stratification.5 The primary outcomes of ureteral injury were compared between patients who underwent colectomy with ureteral stent placement and patients who underwent colectomy without ureteral stent placement. Secondary outcomes of length of stay, in-hospital mortality, procedural duration, and new-onset urinary complication (hematuria, dysuria, or urinary tract infection in the postoperative period) were also compared. The Yale Human Investigation Committee approved this study with waiver of patient consent. Multivariable logistic regression models were created to analyze factors associated with each outcome by a backward elimination technique with a significance threshold for inclusion in the final model of P < .10. Use of ureteral stents was forced into all models to determine the association of prophylactic stenting with each outcome. All analyses were performed using SAS, version 9.4 (SAS Institute Inc). P < .05 was considered significant.