Intraoperative stent use tied to more infectious complications

Use of intraoperative ureteral stent in radical cystectomy/urinary diversion results in significantly higher infectious complications and urgent care visits, a study has shown. It also markedly increases the likelihood of 30-day ureteroenteric anastomosis-related complications.

The authors analysed a prospective database of 283 patients enrolled in a randomized controlled trial investigating 30-day perioperative complications with goal directed fluid therapy following open radical cystectomy/urinary diversion between 2014 and 2018.

Ureteroenteric anastomosis-specific complications (ureteral obstruction, urinary leak, urinary infections/sepsis, and intra-abdominal abscess) were compared between intraoperative stent and nonintraoperative stent groups using Fisher exact test and quantified using logistic regression.

Patients in the nonintraoperative stent group (77/283; 27 percent) were older (median age, 72 vs 69 years) and more likely to receive neoadjuvant chemotherapy (53 percent vs 40 percent), to have baseline renal insufficiency (43 percent vs 30 percent) and to undergo an ileal conduit (92 percent vs 53 percent) than those in the intraoperative stent group.

However, the rate of ureteroenteric anastomosis complications was lower in the nonintraoperative vs intraoperative stent group (14 percent vs 32 percent; p=0.004) despite higher comorbidity.

The former cohort with ileal conduit was also compared to the latter with ileal conduit since continent diversions might be related to higher complications. The result showed that ureteroenteric anastomosis complications remained lower in the nonintraoperative stent group (14 percent vs 28 percent; p=0.043).

In multivariable logistic regression, intraoperative stent use significantly increased the likelihood of urinary complications (odds ratio, 3.55, 95 percent confidence interval, 2.93–4.31; p<0.0001). Moreover, no obstruction was found and only one leak (1.3 percent) was seen in the nonintraoperative stent group.