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Objective: Prophylactic placement of ureteral stents is performed during open colectomy to aid in ureteral identification and enhance detection of injury. The effects of this practice in laparoscopic colectomy are unknown. This study evaluated outcomes of ureteral stenting in laparoscopic colectomy.
Design: Retrospective cohort
Setting: Tertiary academic medical center
Patients: 578 consecutive patients undergoing elective laparoscopic colectomy from 2014 - 2016 for malignant (49%) or non-malignant indications (51%).
Main outcome measures: Primary outcome measures included incidence of ureteral injury. Secondary outcomes included mortality, length of stay, procedural duration, urinary complication (hematuria, dysuria and UTI), and cost of hospitalization.
Results: Prophylactic stents were placed in 219 (38%) patients who underwent laparoscopic colectomy. Two ureteral injuries occurred (0.3%), both in patients who underwent ureteral stent placement (p=0.95), and were repaired intraoperatively. There was no in-hospital mortality. When accounting for age-adjusted Charlson co-morbidity score, procedural indication, gender, BMI and extent of resection, no difference in hospital length of stay (p=0.59) was noted comparing patients with and without stenting. However, stent placement prolonged OR times (p=0.04) and increased indirect hospitalization costs by $2,586 (p<0.0001). There was no difference in urinary symptoms after stent placement in the overall cohort (OR=1.57, 95% CI=0.74-3.29, p=0.24), though the incidence was significantly increased after stent placement in those patients undergoing colectomy for malignancy (OR=3.37, 95% CI=1.20-9.43, p=0.02).
Conclusions: In this study, ureteral injuries only occurred in those with stent placement. In patients undergoing laparoscopic colectomy, ureteral stenting is associated with longer operative times and greater indirect hospitalization costs, without notable differences in the incidence of ureteral injury. Prospective studies are needed to determine the benefits of ureteral stenting in patients undergoing elective laparoscopic colectomy.