Login to Access Video or Poster Abstract: MP24-09
Sources of Funding: None

Introduction

Iatrogenic ureteral injury is a rare (0.38%) but serious complication after colorectal surgery. Lighted ureteral stents (LUS) have been used to aid in the visual identification of the ureters during minimally invasive approaches. We aim to investigate the technical challenges, complications, and cost of LUS placement at our institution.

Methods

A retrospective review was performed on all laparoscopic and robotic colorectal procedures at our institution between March 2011 and October 2016 where LUS were requested. Illuminated single lumen ureteral stents were placed and removed at the end of each procedure. Technical challenges with LUS placement and postoperative complications such as ureteral injury, hematuria and acute kidney injury (AKI) were evaluated. Statistical analysis was performed using SPSS v24.

Results

LUS were placed during 120 laparoscopic or robotic-assisted bowel resections. Technical challenges were encountered in 15% of cases (n=18), requiring dilatation of the urethra (n=4) or ureter(n=5), or placement of a non-illuminated stent (n=8). Mean operative time for complicated vs uncomplicated LUS placement was 26.4 minutes (STD=14.69) and 14.2 minutes (STD=9.35) respectively (p<0.001). Estimated cost of complicated vs uncomplicated stent placement was $1472.33 (STD=555.13) and $954.15 (STD=265.58) respectively (p=0.001). Estimated cost of bilateral vs unilateral LUS placement was $1209.90 (STD=321.65) and $865.34 (STD=378.01) respectively (p<0.001).Postoperative AKI was encountered in 9% of cases (n=11). Of these, 72% (n=8) received bilateral LUS, 18% (n=2) received unilateral LUS, and 9% (n=1) received an open-ended ureteral stent due to inability to place a LUS (p=0.095). In total, 52 cases received bilateral LUS and 15% of these (n=8) developed postoperative AKI. All AKI episodes were self-limited except in one patient who received bilateral LUS and developed postoperative oliguria, worsening creatinine, and mild hydronephrosis, requiring bilateral indwelling ureteral stent placement. 3% of patients (n=4) developed postoperative hematuria that resolved without intervention. There was one ureteral injury despite bilateral LUS, which was identified intraoperatively and repaired robotically via ureteroureterostomy.

Conclusions

We found that complications associated with LUS placement are rare and mostly self-limited. While illuminated stents may improve intraoperative identification of the ureters, further investigation is needed to determine their effectiveness in the prevention of ureteral injury.

Funding

None