BACKGROUND AND PURPOSE:

• Scaglione et al. (Obstetrics & Gynecology, 2022) evaluated the association between prophylactic ureteral stent placement at the time of hysterectomy for placenta accreta spectrum and genitourinary injury

METHODS:

• Retrospective cohort study
• Population
  • Patients with placenta accreta spectrum who underwent hysterectomy from 2001 to 2021
• Exposure
  • Prophylactic ureteral stent placement
• Study design
  • Odds ratios (OR) and adjusted odds ratios (aOR) were calculated using multivariable logistic regression analyses, with control for potential confounding variables
  • Prior to 2018: Use of stents was determined on a case-by-case basis and at the discretion of the attending surgeon
  • September 2018 and later: Ureteral stents placed routinely
  • Attending surgeon subspecialties
    • General ObGyn | Minimally Invasive Gynecology | MFM | Gyn Oncology 
• Primary outcome
  • Genitourinary injury: Composite of bladder injury, ureteral injury, or vesicovaginal fistula
• Secondary outcomes
  • Components of the primary outcome

RESULTS:

• 236 patients
  • Prophylactic ureteral stents used: 66%
• Genitourinary injury occurred less frequently in the stent group
  • Stent group: 28%
  • No stent group: 51%
  • OR 0.37 (95% CI, 0.21 to 0.65)
• This association persisted after controlling for urgency of delivery, three or more prior cesarean deliveries, and whether a gynecologic oncologist was present
  • aOR 0.27 (95% CI, 0.14 to 0.52)
• Individual injuries also occurred less frequently in the stent group compared with the no stent group
  • Bladder injury (P=0.018)
    • Stent group: 13%
    • No stent group: 25%
  • Ureteral injury (P=0.019)
    • Stent group: 2%
    • No stent group: 9%

CONCLUSION:

• The use of prophylactic ureteral stents during cesarean hysterectomy for placenta accreta spectrum was associated with an 80% reduction in risk for genitourinary injury vs no stent use
• The authors state

Longer surgery due to cystoscopy and stenting is an important consideration, because it may be associated with additional morbidity and cost

One solution to this time problem may be to place stents concurrently with the start of the cesarean delivery, which we have begun to do more often

Learn More – Primary Sources:

Prophylactic Ureteral Stent Placement and Urinary Injury During Hysterectomy for Placenta Accreta Spectrum

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