eP451 - Prophylactic Ureteral Stents in Complex Pelvic Surgery and Rates of Acute Kidney Injury

Purpose/Background: Prophylactic ureteral catheterization (PUC) is a strategy aimed at preventing intraoperative ureteral injury. It has gained acceptance as a technique to assist in identifying the ureter during surgery. However, there is ongoing debate regarding the acceptance and application of PUC, as there are mixed reports regarding its advantages, complications, and cost-effectiveness. While certain authors claim reduced rates of intraoperative ureteral injury with PUC, aggregated data has failed to conclusively demonstrate its clinical benefits. The objective of this study was to determine the effect of prophylactic ureteral catheterization on kidney function in patients undergoing complex pelvic surgery at our center.Methods/Interventions: This was a retrospective, cohort study including adult patients who underwent complex pelvic surgery with PUC by either gynecology or colon and rectal surgery from January 2020 to March 2023. Descriptive statistics were utilized. For the primary outcome, we defined acute kidney injury as a postoperative increase in creatinine levels equal to or greater than 0.3 mg/L compared to baseline. Descriptive operative characteristics such as blood loss, operative time, 30 day perioperative complications and length of stay were also reviewed.Results/Outcomes: A total of 50 patients were included. The average age of the participants was 49 years (SD 12), and the mean body mass index (BMI) was 30 kg/m² (SD 8.5). Among the subjects, 40% were of white ethnicity, 26% were black, and 27% identified as Hispanic. 12% of the cohort had diabetes while 44% had hypertension. Notably, 66% of the patients had previously undergone pelvic surgery. One patient was ASA class IV, while 15 patients (30%) were categorized as ASA class III. Five patients received a colorectal cancer diagnosis upon final pathology examination. All patients underwent prophylactic bilateral ureteral catheterization using 5 French catheters. In 32% of cases, indocyanine green (ICG) was injected into the catheters and capped. The average duration of catheter placement was 11.5 minutes, ranging from 8 to 20 minutes. The median surgical duration was 161 minutes, with a range of 136 to 240 minutes. On average, blood loss during surgery amounted to 100 milliliters, varying from 30 to 200 milliliters.In two cases, a double J stent was inserted due to intraoperative bladder cystotomy and subsequent repair. Acute kidney injury was observed in 10 patients, accounting for 20% of the cohort. Complications, categorized according to the Clavien-Dindo Classification, were as follows: Grade 1 (8%), Grade 2 (3%), Grade 3a (2%), and Grade 3b (4%). The rate of readmission within 30 days after surgery was 6%.Conclusion/

Discussion: While PUCs assist with identification of ureters during complex pelvic surgery, they also entail risks of acute kidney injury (AKI). Larger, prospective, randomized studies are needed to determine the risk benefit ratio of PUC for complex pelvic operations.