Introduction

Prophylactic Ureteral Localization Stents (PULSe) aid in intraoperative localization and detection of suspected ureteral injury during complex Colorectal Surgery cases. We previously reported the incidence of urologic induced Clavien grade III complications of PULSe placement at our institution from July 2013 to June 2014 is estimated at 4%. As a quality health initiative, we sought to compare a modification of technique, mandatory use of guidewire assistance during PULSe placement to reduce urologic induced complications in this patient cohort.

Methods

Following results of the above study, we made guidewire usage during PULSe placement mandatory at our institution. We reviewed all patients who underwent cystoscopy and PULSe placement at the time of CRS over a 12 month period (July 2015 to June 2016). Bilateral 5 French x 70 cm TigerTail (Bard Medical Division, Covington, GA) PULSe devices were placed with use of guidewire. Flouroscopy was not used. We compared this patient cohort to our prior cohort from July 2013 to June 2014 with the following variables: age, BMI, American Society of Anesthesiologists (ASA) score, preoperative creatinine, postoperative creatinine, pre/postoperative creatinine difference, and Clavien III urologic induced complications.

Results

132 patients with a mean age and BMI of 55.78 (18 to 89) and 27.02, respectively underwent bilateral PULSe placement with mandatory use of guidewire. Mean pre and postprocedural creatinine levels were 0.91 and 1.04, respectively with a mean pre/post procedural creatinine difference of 0.09. No Clavien III complications were encountered in the contemporary cohort, compared to the prior incidence of 4% (p≤0.001). Moreover, postoperative creatinine and pre/postprocedural creatinine difference also favored the contemporary cohort (p≤0.022 and p≤0.003, respectively).

Conclusions

Mandatory use of guidewire prior to PULSe placement reduced our incidence of urologic induced Clavien III complications to zero. Benefits were also observed in postoperative and pre/post procedural renal function with use of guidewire.

Funding

none