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

Autor: Pompeu BF; Department of Colorectal Surgery, Heliopolis Hospital, São Paulo, Brazil. bernardo.pompeu@online.uscs.edu.br.; Department of General Surgery, Heliopolis Hospital, São Paulo, Brazil. bernardo.pompeu@online.uscs.edu.br.; University of São Caetano do Sul - USCS, São Caetano do Sul, Brazil. bernardo.pompeu@online.uscs.edu.br., de Arruda Ribeiro CT; Department of General Surgery, Heliopolis Hospital, São Paulo, Brazil., Pasqualotto E; Federal University of Santa Catarina, Florianópolis, Brazil., Delgado LM; Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil., de Souza Pinto Guedes LS; University of São Caetano do Sul - USCS, São Caetano do Sul, Brazil., de Figueiredo SMP; Department of Surgery, University of North Carolina, Chapel Hill, NC, USA., Borges L; Department of Urology, Albert Einstein Hospital, São Paulo, Brazil., Formiga FB; Department of Colorectal Surgery, Heliopolis Hospital, São Paulo, Brazil.; Department of General Surgery, Heliopolis Hospital, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: International urology and nephrology [Int Urol Nephrol] 2024 Oct 08. Date of Electronic Publication: 2024 Oct 08.
DOI: 10.1007/s11255-024-04224-0
Abstrakt: 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 I 2 statistics, with p-values inferior to 0.10 and I 2  > 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; I 2  = 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; I 2  = 44%), operative time (MD 24.8 min; 95% CI 4.9-44.8; p = 0.01; I 2  = 91%), and a decrease in mortality (OR 0.11; 95% CI 0.05-0.23; p < 0.001; I 2  = 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.
(© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)
Databáze: MEDLINE
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