Category: Reconstruction: Outcomes & Complications

MP14-15 - The outcomes of ureterolysis during surgery for deep infiltrating endometriosis in stented patients

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

The UK National Institute for Health and Care Excellence recommends multidisciplinary team working for patients with deep infiltrating endometriosis. When ureteric involvement requiring extensive ureterolysis is suspected, intraoperative stents are inserted. We sought to determine the incidence of subsequent ureteric stricture development and the need for long term stenting in these patients.


Methods :

Our tertiary referral unit database was used to identify patients who underwent endometriosis surgery from 2011-15. Data were collected on pre-operative loin pain and hydronephrosis, intra-operative stenting requirement, subsequent stent management and whether post-operative renal obstruction occurred (as determined by MAG3 scan). Fisher’s Exact Test was used to determine significance.


Results :

239 patients were identified, of whom 15% (36/239) had ureteric stents inserted intraoperatively. Of these, 22% (8/36) had pre-operative hydronephrosis, 22% (8/36) had pre-operative loin pain and 14% (5/36) had both. There was thought to be a greater post-operative risk of obstruction in stented patients (i.e “high risk” intraoperative cases) compared with unstented patients (p=0.07), but no difference in stricture formation in patients whose stents were simply removed cystoscopically or after ureteroscopic assessment (p=1.0).


Conclusions :

These data show a low overall risk of post-operative ureteric complications in patients managed with urological input peri-operatively. This supports the conclusion that intra-operative stent insertion for “high risk” cases facilitates a similar outcome to less complex patients who did not need stents at all. Post-operative ureteroscopic assessment does not appear to be needed as it is not predictive of final functional outcome. Instead, unless there are specific concerns, out-patient stent removal with a flexible cystoscope and MAG3 scan 4 weeks later seems sufficient for upper tract follow up.

Daron Smith

Consultant Urological Surgeon
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Daron Smith is a consultant urological surgeon at the Institute of Urology at University College Hospital. His practice is "endoluminal endourology" and encompasses the comprehensive management of Urinary Tract Stone disease, and includes the endourological management of ureteric obstruction, ureteric injuries, and the endoscopic diagnosis and management of upper tract TCC. He is the vice-chairman of the BAUS Section of Endourology, having been its Secretary from 2015-17 and a committee member since 2013, is the Consulting Editor on stone disease for the BJUI and the deputy editor of the Journal of Endoluminal Endourology

Michael Mikhail

Trainee
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Guy Fisher

UCLH Endometriosis Centre, Department of Gynaecology, University College London Hospital
London, England, United Kingdom

Vimoshan Arumuham

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Sian Allen

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Arvind Vashisht

UCLH Endometriosis Centre, Department of Gynaecology, University College London Hospital
London, England, United Kingdom

Ertan Saridogan

UCLH Endometriosis Centre, Department of Gynaecology, University College London Hospital
London, England, United Kingdom

Alfred Cutner

UCLH Endometriosis Centre, Department of Gynaecology, University College London Hospital
London, England, United Kingdom