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

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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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Author notes

  1. David Quinlan and Des C. Winter are senior authors

Authors and Affiliations

  1. Department of Urology, St Vincent’s University Hospital, Elm Park, Dublin, Ireland

    Stefanie M. Croghan, David Mulvin, Barry B. McGuire, Michael Murphy, David J. Galvin, Gerry Lennon & David Quinlan

  2. Department of Surgery, St Vincent’s University Hospital, Dublin, Ireland

    Alexandra Zaborowski, Helen M. Mohan & Des C. Winter

  3. Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland

    Alexandra Zaborowski, Helen M. Mohan & Des C. Winter

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  1. Stefanie M. Croghan
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Correspondence to Stefanie M. Croghan.

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Croghan, S.M., Zaborowski, A., Mohan, H.M. et al. The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections. Int J Colorectal Dis 34, 1161–1178 (2019). https://doi.org/10.1007/s00384-019-03314-1

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