Prophylactic ureteral stent in colorectal surgery: a meta-analysis and systematic review

Abstract

Purpose: Accidental ureteric injury during colorectal surgery is a rare but dreadful event. It is associated with a higher risk of urinary tract infection (UTI) and acute kidney injury (AKI). Prophylactic placement of double J stents could improve ureteral identification and decrease the chance of accidental ureteral injury.

Methods: We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science for studies published until March 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I² statistics, with p-values inferior to 0.10 and I² > 25% considered significant. Statistical analysis was conducted in RStudio version 4.4.1.

Results: Eleven observational studies were included, comprising 71,784 patients. Among them, 11,723 (16.4%) were submitted to a prophylactic ureteral stent while 59,961 (83.6%) were not. There was no significant difference in ureteral injury between the groups (0.66% vs 0.8%; OR 1.45; 95% CI 0.43-4.87; p = 0.552; I² = 56%). Prophylactic stent placement was associated with an increase in AKI (1.7% vs. 0.56%; OR 1.54; 95% CI 1.24-1.91; p < 0.001; I² = 44%), operative time (MD 24.8 min; 95% CI 4.9-44.8; p = 0.01; I² = 91%), and a decrease in mortality (OR 0.11; 95% CI 0.05-0.23; p < 0.001; I² = 42%). No differences were observed in UTI, hematuria, length of hospital stays, and reoperation.

Conclusion: In colorectal surgery, prophylactic ureteral stents were associated with increased AKI and operative time. No significant difference was observed in ureteral injury, UTI, hematuria, length of hospital stays, and reoperation.

Keywords: Colorectal neoplasm cancer; Colorectal surgery; Diverticulitis; Minimally invasive surgery; Ureteral stent.