Complications Of Peri-Operative Ureteral Catheter Placement: Experience at A Major Cancer Center - 13/06/22

Doi : 10.1016/j.urology.2021.04.068

Albert A. Geskin ^a,^b, O. Lenaine Westney ^b, William J. Graber ^b, Thomas G. Smith III ^b, Brian F. Chapin ^b, Justin R. Gregg ^b,^⁎
^a University of Texas Medical School at Houston, Houston, TX
^b University of Texas MD Anderson Cancer Center, Houston, TX

^⁎Address correspondence to: Justin R. Gregg, MD, 1155 Pressler Street, Unit 1373, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030.Department of Urology, Division of SurgeryThe University of Texas MD Anderson Cancer Center1155 Pressler Street, Unit 1373HoustonTX77030

Highlights

•	After peri-operative ureteral catheterization, 1.7% of patients develop ureteral obstruction requiring intervention.
•	These data may be used for pre-operative counseling and decision-making regarding use of ureteral catheters.
•	Interventions to mitigate complication risk following ureteral catheter placement are currently unknown

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Abstract

Objective

To evaluate risks of peri-operative ureteral catheter placement in a consecutive patient-series.

Methods

Patients who underwent peri-operative ureteral catheter placement at a single institution in 2018 were included. A retrospective review was conducted to evaluate patient and procedure related characteristics, including data on technique, perceived placement difficulty, operative details, and complications.

Outcome Measurements and Statistical Analysis

Urologic complications within 30 days were evaluated using the Clavien-Dindo system. Statistical analysis for association was conducted using the X2 test or fisher's exact tests.

Results

413 patients were included. 50/413 (12.1%) cases had urologic complications within 30 days. 43 were Clavien-Dindo grade I-II. Six were grade III. 5/6 patients had oliguric, obstructive AKI. One had flank pain with hydronephrosis. Two patients each underwent placement of unilateral nephrostomy tube, bilateral double-J stent placement, and unilateral stent placement. One patient had a Grade V complication. They developed multi-system organ failure including renal failure with hydronephrosis.All patients who required re-intervention had bilateral peri-operative catheterization with use of a wire. Intraoperative difficulty with placement was associated with high-grade complication (P<.01)). Limitations include retrospective,single center study design.

Conclusions

Rate of acute complication following ureteral catheter placement is 12%. 1.7% of patients develop post-operative ureteral obstruction requiring intervention within 30 days. Future studies are needed to determine patients most at risk for post-ureteral stent complication.

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