Presentation Authors: Ram Pathak, Chris Brooks*, Garrett Thomas, Carl Edge, Ashok Hemal, Winston-Salem, NC
Introduction: We previously reported the incidence of urologic-induced Clavien grade III complications of Prophylactic Ureteral Localization Stents (PULSe) is estimated at 2%. Conclusions of this study raised the possibility of mandatory guidewire utilization prior to all PULSe placement, as this was not obligatory in the initial series. As a quality improvement project, we sought to compare a modification of technique, mandatory use of guidewire, prior to PULSe placement to reduce urologic-induced complications in this patient cohort. Moreover, we performed a systematic review of the literature to determine the overall incidence of urologic-induced complications in patients undergoing PULSe placement.
Methods: We performed a retrospective review of all patients who underwent cystoscopy andPULSe placement at the time of General Surgical Procedure over a 12-month period. We compared this patient cohort to our prior cohort from July 2013 to June 2014 with the following variables: age, BMI, ASA score, pre-operative creatinine, post-operative creatinine, pre/post-operative creatinine difference, and Clavien III urologic-induced complications. We then performed a literature review from 1985-2018 using the following search terms: â€˜prophylactic ureteral stentâ€™ and â€˜localization stentâ€™. Of the 145 studies reviewed, 14 publications met our inclusion criteria of PULSe prior to surgical procedure for the purpose of ureteral localization.
Results: In a current institutional series, 132 patients with a mean age and BMI of 55.78 (18-89) and 27.02, respectively, underwent bilateral PULSe placement with mandatory use of guidewire. No Clavien III complications were encountered in the contemporary cohort, compared to the prior incidence of 2% (p < 0.001) Moreover, post-operative creatinine and pre/post-procedural creatinine difference also favored the contemporary cohort (p < 0.022 and p < 0.003, respectively). Review of literature and complication profile can be seen in Table 1. Overall urologic-induced complication rate in the literature is 2.47%.
Conclusions: Mandatory use of guidewire prior to PULSe placement reduced our incidence of urologic-induced Clavien III complications to zero. The literature varies with respect to use of guidewire or fluoroscopy during PULSe placement