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07.06.2019 | Review | Ausgabe 7/2019

International Journal of Colorectal Disease 7/2019

The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections

Zeitschrift:
International Journal of Colorectal Disease > Ausgabe 7/2019
Autoren:
Stefanie M. Croghan, Alexandra Zaborowski, Helen M. Mohan, David Mulvin, Barry B. McGuire, Michael Murphy, David J. Galvin, Gerry Lennon, David Quinlan, Des C. Winter
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00384-019-03314-1) contains supplementary material, which is available to authorized users.
David Quinlan and Des C. Winter are senior authors

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

Purpose

‘Prophylactic’ ureteric stents potentially reduce rates, and facilitate intraoperative recognition, of iatrogenic ureteric injury (IUI) during colorectal resections. A lack of consensus surrounds the risk–benefit equation of this practice, and we aimed to assess the evidence base.

Methods

A systematic review was performed according to PRISMA guidelines. MEDLINE, Scopus, EMBASE and Cochrane databases were searched using terms ‘ureteric/ureteral/JJ/Double J stent’ or ‘ureteric/ureteral catheter’ and ‘colorectal/prophylactic/resection/diverticular disease/diverticulitis/iatrogenic injury’. Primary outcomes were rates of ureteric injuries and their intraoperative identification. Secondary outcomes included stent complication rates.

Results

We identified 987 publications; 22 papers met the inclusion criteria. No randomised controlled trials were found. The total number of patients pooled for evaluation was 869,603 (102,370 with ureteric stents/catheters, 767,233 controls). The most frequent indications for prophylactic stents were diverticular disease (45.38%), neoplasia (33.45%) and inflammatory bowel disease (9.37%). Pooled results saw IUI in 1521/102,370 (1.49%) with, and in 1333/767,233 (0.17%) without, prophylactic ureteric stents. Intraoperative recognition of IUIs occurred in 10/16 injuries (62.5%) with prophylactic stents, versus 9/17 (52.94%) without stents (p = 0.579). The most serious complications of prophylactic stent use were ureteric injury (2/1716, 0.12%) and transient ureteric obstruction following stent removal (13/666, 1.95%).

Conclusions

Placement of prophylactic ureteric stents has a low complication rate. There is insufficient evidence to conclude that stents decrease ureteric injury or increase intraoperative detection of IUIs. Apparently higher rates of IUI in stented patients likely reflect use in higher risk resections. A prospective registry with harmonised data collection points and stratification of intraoperative risk is needed.

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Zusatzmaterial
ESM 1 (PDF 1903 kb)
384_2019_3314_MOESM1_ESM.pdf
ESM 2 (PDF 59 kb)
384_2019_3314_MOESM2_ESM.pdf
ESM 3 (DOCX 90 kb)
384_2019_3314_MOESM3_ESM.docx
Literatur
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