David Zimmerman

Replying to @ZimNl

Sean Langenfeld Verified account @SeanLangenfeld · Aug 26

A commonly quoted piece of surgical dogma is that ureteral stents do not prevent ureteral injury in complex CRS, but they do allow for swifter identification of injuries.

This is nonsense.

All studies on the topic are retrospective where stent placement was reflective of proper selection bias in more difficult cases. The fact that most of these studies don't show a difference in injury rates is probably proof of stent efficacy in itself.

If you wanted to create a robust RCT on the topic, you would need thousands (and thousands) of patients to be adequately powered. Even then there would be bias, as accrual would be impacted by the surgeon's concern for ureteral identification.

Meanwhile, for those of us who do the most difficult colorectal surgeries, we use stents selectively and are quite grateful for their guidance when concrete awaits us in the retroperitoneum. If nothing else, stents certainly save some time and allow for a better game plan in these tough cases.

Conversely, stents are not a "free lunch" and I've certainly seen complications from placement. They're also inconvenient, disruptive, and poorly-reimbursed for our wonderful urology colleagues.

I don't see an easy solution, and surgeons should definitely avoid routine/blind requests for stents. But, complete abandonment accompanied by the mantra of "stents don't prevent injuries" is just unrealistic for those of us who are millimeters away from ureteral injury on a daily basis.

Here's some studies for those interested in reading more:
pubmed.ncbi.nlm.nih.gov/37227585/
pubmed.ncbi.nlm.nih.gov/33340227/
pubmed.ncbi.nlm.nih.gov/29215477/

View quoted post on X