Jacob E Tallman, Emily A Vertosick, Syed M Alam, Fady J Baky, S Machele Donat, Eugene J Pietzak, Eugene K Cha, Timothy F Donahue, Bernard H Bochner, Andrew J Vickers, Alvin C Goh
{"title":"体外回肠导管机器人辅助根治性膀胱切除术的围手术期并发症和输尿管支架的遗漏。","authors":"Jacob E Tallman, Emily A Vertosick, Syed M Alam, Fady J Baky, S Machele Donat, Eugene J Pietzak, Eugene K Cha, Timothy F Donahue, Bernard H Bochner, Andrew J Vickers, Alvin C Goh","doi":"10.1097/JU.0000000000004387","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Ureteral stents are commonly placed intraoperatively during radical cystectomy, although their efficacy in reducing complications is unproven. We compared clinical outcomes among patients undergoing robot-assisted radical cystectomy with intracorporeal ileal conduit (RARC-IC) with or without ureteral stents to determine if omission of ureteral stents affects postoperative complications.</p><p><strong>Materials and methods: </strong>All RARC-IC surgeries performed at our institution between November 2017 and June 2023 were reviewed. Beginning August 2021, ureteral stents were routinely omitted. Primary outcome was ureteroenteric anastomosis complications (urine leak, UTI, abscess, and/or sepsis) within 30 and 90 days of RARC-IC. Secondary outcomes included rates of wound infections, urgent care center visits, inpatient readmissions, and ureteral stricture.</p><p><strong>Results: </strong>Among 133 patients included, 90 patients (68%) received a ureteral stent and 43 (32%) did not. Composite ureteroenteric anastomosis complications were higher in the stented group (20% vs 9.5%, 10% difference, 95% CI, -3.4% to 24%, <i>P</i> = .2), though not statistically significant. The stented group had a significantly higher 30-day UTI rate (19% difference, 95% CI, 9.0%-29%, <i>P</i> = .007). The 30-day readmission rates were higher in the stented group, although differences did not meet statistical significance (19% vs 9.8%, 9.1% difference, 95% CI, -4.8% to 23%, <i>P</i> = .3). Limitations include lack of randomization and inability to evaluate some outcomes, including ureteral obstruction or strictures.</p><p><strong>Conclusions: </strong>Omission of ureteral stent placement at RARC-IC is safe and feasible. Randomized trials are warranted to determine the effects of stents on risk of postoperative complications after RARC-IC.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"437-446"},"PeriodicalIF":5.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888893/pdf/","citationCount":"0","resultStr":"{\"title\":\"Perioperative Complications and Omission of Ureteral Stents During Robot-Assisted Radical Cystectomy With Intracorporeal Ileal Conduit.\",\"authors\":\"Jacob E Tallman, Emily A Vertosick, Syed M Alam, Fady J Baky, S Machele Donat, Eugene J Pietzak, Eugene K Cha, Timothy F Donahue, Bernard H Bochner, Andrew J Vickers, Alvin C Goh\",\"doi\":\"10.1097/JU.0000000000004387\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Ureteral stents are commonly placed intraoperatively during radical cystectomy, although their efficacy in reducing complications is unproven. We compared clinical outcomes among patients undergoing robot-assisted radical cystectomy with intracorporeal ileal conduit (RARC-IC) with or without ureteral stents to determine if omission of ureteral stents affects postoperative complications.</p><p><strong>Materials and methods: </strong>All RARC-IC surgeries performed at our institution between November 2017 and June 2023 were reviewed. Beginning August 2021, ureteral stents were routinely omitted. Primary outcome was ureteroenteric anastomosis complications (urine leak, UTI, abscess, and/or sepsis) within 30 and 90 days of RARC-IC. Secondary outcomes included rates of wound infections, urgent care center visits, inpatient readmissions, and ureteral stricture.</p><p><strong>Results: </strong>Among 133 patients included, 90 patients (68%) received a ureteral stent and 43 (32%) did not. Composite ureteroenteric anastomosis complications were higher in the stented group (20% vs 9.5%, 10% difference, 95% CI, -3.4% to 24%, <i>P</i> = .2), though not statistically significant. The stented group had a significantly higher 30-day UTI rate (19% difference, 95% CI, 9.0%-29%, <i>P</i> = .007). The 30-day readmission rates were higher in the stented group, although differences did not meet statistical significance (19% vs 9.8%, 9.1% difference, 95% CI, -4.8% to 23%, <i>P</i> = .3). Limitations include lack of randomization and inability to evaluate some outcomes, including ureteral obstruction or strictures.</p><p><strong>Conclusions: </strong>Omission of ureteral stent placement at RARC-IC is safe and feasible. Randomized trials are warranted to determine the effects of stents on risk of postoperative complications after RARC-IC.</p>\",\"PeriodicalId\":17471,\"journal\":{\"name\":\"Journal of Urology\",\"volume\":\" \",\"pages\":\"437-446\"},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888893/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JU.0000000000004387\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JU.0000000000004387","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/12 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:输尿管支架通常在根治性膀胱切除术术中放置,尽管其减少并发症的功效尚未得到证实。我们比较了机器人辅助根治性膀胱切除术(RARC-IC)伴输尿管支架或不伴输尿管支架的患者的临床结果,以确定输尿管支架是否会影响术后并发症。材料和方法:回顾2017年11月至2023年6月在我院进行的所有RARC-IC手术。从2021年8月开始,常规省略输尿管支架。主要结局是RARC-IC术后30天和90天内输尿管-肠吻合术(UEA)并发症(尿漏、尿路感染、脓肿和/或脓毒症)。次要结局包括伤口感染、急诊中心就诊、住院再入院和输尿管狭窄的发生率。结果:纳入的133例患者中,90例(68%)接受了输尿管支架,43例(32%)未接受。支架组复合UEA并发症较高(20% vs 9.5%,差异10%,95% CI, -3.4%-24%, p = 0.2),但无统计学意义。支架组30天UTI发生率显著高于支架组(差异19%,95% CI, 9.0%-29%, p = 0.007)。支架组30天再入院率较高,但差异无统计学意义(19% vs 9.8%,差异9.1%,95% CI, -4.8%-23%, p = 0.3)。局限性包括缺乏随机化和无法评估一些结果,包括输尿管梗阻或狭窄。结论:RARC-IC输尿管支架置入术是安全可行的。需要随机试验来确定支架对RARC-IC术后并发症风险的影响。
Perioperative Complications and Omission of Ureteral Stents During Robot-Assisted Radical Cystectomy With Intracorporeal Ileal Conduit.
Purpose: Ureteral stents are commonly placed intraoperatively during radical cystectomy, although their efficacy in reducing complications is unproven. We compared clinical outcomes among patients undergoing robot-assisted radical cystectomy with intracorporeal ileal conduit (RARC-IC) with or without ureteral stents to determine if omission of ureteral stents affects postoperative complications.
Materials and methods: All RARC-IC surgeries performed at our institution between November 2017 and June 2023 were reviewed. Beginning August 2021, ureteral stents were routinely omitted. Primary outcome was ureteroenteric anastomosis complications (urine leak, UTI, abscess, and/or sepsis) within 30 and 90 days of RARC-IC. Secondary outcomes included rates of wound infections, urgent care center visits, inpatient readmissions, and ureteral stricture.
Results: Among 133 patients included, 90 patients (68%) received a ureteral stent and 43 (32%) did not. Composite ureteroenteric anastomosis complications were higher in the stented group (20% vs 9.5%, 10% difference, 95% CI, -3.4% to 24%, P = .2), though not statistically significant. The stented group had a significantly higher 30-day UTI rate (19% difference, 95% CI, 9.0%-29%, P = .007). The 30-day readmission rates were higher in the stented group, although differences did not meet statistical significance (19% vs 9.8%, 9.1% difference, 95% CI, -4.8% to 23%, P = .3). Limitations include lack of randomization and inability to evaluate some outcomes, including ureteral obstruction or strictures.
Conclusions: Omission of ureteral stent placement at RARC-IC is safe and feasible. Randomized trials are warranted to determine the effects of stents on risk of postoperative complications after RARC-IC.
期刊介绍:
The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.