Ureteral stent omission safe, feasible in RARC-IC

A recent study has shown the safety and feasibility of omitting ureteral stent placement during robot-assisted radical cystectomy with intracorporeal ileal conduit (RARC-IC).

Investigators reviewed all RARC-IC surgeries carried out between November 2017 and June 2023 at an institution. Ureteral stents were routinely omitted starting August 2021.

The primary outcome was ureteroenteric anastomosis complications (ie, urine leak, UTI, abscess, and/or sepsis) within 30 and 90 days of RARC-IC. Other outcomes assessed were the rates of wound infections, urgent care centre visits, inpatient readmissions, and ureteral stricture.

Of the 133 patients included, 90 (68 percent) received a ureteral stent and 43 (32 percent) did not. The stented group showed higher composite ureteroenteric anastomosis complications (20 percent vs 9.5 percent; 10-percent difference, 95 percent confidence interval [CI], ‒3.4 to 24; p=0.2), but this did not reach statistical significance.

Patients with a ureteral stent also had a significantly higher rate of UTI within 30 days (19-percent difference, 95 percent CI, 9.0‒29; p=0.007), as well as a higher 30-day readmission rate (19 percent vs 9.8 percent; 9.1-percent difference, 95 percent CI, ‒4.8 to 23; p=0.3), although the latter was not statistically significant.

The study was limited by the lack of randomization and inability to assess other outcomes, such as ureteral obstruction or strictures.

“Randomized trials are warranted to determine the effects of stents on risk of postoperative complications after RARC-IC,” the investigators said.