PURPOSE Ureteral stents are commonly placed intraoperatively during radical cystectomy, though 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 (UEA) complications (urine leak, urinary tract infection [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 UEA complications were higher in the stented group (20% vs 9.5%, 10% difference, 95% CI, -3.4%-24%, p = 0.2), though not statistically significant. The stented group had a significantly higher 30-day UTI rate (19% difference, 95% CI, 9.0%-29%, p = 0.007). 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%-23%, p = 0.3). Limitations include lack of randomization and inability 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.

中文翻译：

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使用体内回肠导管进行机器人辅助根治性膀胱切除术期间的围手术期并发症和输尿管支架的遗漏。


目的 输尿管支架通常在根治性膀胱切除术中放置在术中，尽管它们在减少并发症方面的功效尚未得到证实。我们比较了接受机器人辅助根治性膀胱切除术联合体内回肠导管 （RARC-IC） 伴或不伴输尿管支架的患者的临床结局，以确定漏诊输尿管支架是否影响术后并发症。材料和方法 回顾了 2017 年 11 月至 2023 年 6 月期间在我们机构进行的所有 RARC-IC 手术。从 2021 年 8 月开始，输尿管支架通常被省略。主要结局是 RARC-IC 后 30 天和 90 天内输尿管肠吻合术 （UEA） 并发症 （尿漏、尿路感染 [UTI]、脓肿和/或败血症）。次要结局包括伤口感染率、紧急护理中心就诊率、住院再入院率和输尿管狭窄。结果 在纳入的 133 例患者中，90 例 （68%） 接受了输尿管支架，43 例 （32%） 未接受。支架置入组复合 UEA 并发症更高 （20% vs 9.5%，差异 10%，95% CI，-3.4%-24%，p = 0.2），但无统计学意义。支架置入组 30 天 UTI 发生率显著升高 （19% 差异，95% CI，9.0%-29%，p = 0.007）。支架置入组的 30 天再入院率较高，但差异未达到统计学意义 （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某些结局，包括输尿管梗阻或狭窄。结论 RARC-IC 不放置输尿管支架是安全可行的。有必要进行随机试验来确定支架对 RARC-IC 术后并发症风险的影响。