EP2035 - Ureteral Stenting During Minimally Invasive Low Anterior Resection Is Associated with Increased Morbidity: A U.S. Multicenter 90-Day Propensity-Matched Analysis

Purpose/Background: Ureteral stents have traditionally been used during low anterior resection (LARS) to facilitate intraoperative ureteral identification, yet evidence supporting their clinical benefit remains limited. As experience has grown with robotic and minimally invasive surgery, the utilization of stents for this purpose has been called into question. This study evaluated the 90-day postoperative outcomes associated with stent placement using a large, real-world U.S. dataset.

Methods/Interventions: This was a retrospective cohort analysis of the 2010-2024 TriNetX U.S. Collaborative Network database. Patients who underwent elective low anterior resection were identified using CPT codes 44145, 44146, 44207 and 44208. Patients were further stratified into two groups based on prophylactic ureteral stent placement. After 1:1 propensity-score matching for demographics, comorbidities, and pre-operative lab-work, 90-day outcomes were measured including ureteral or genitourinary injury, acute kidney injury (AKI), venous thromboembolism (VTE), postoperative urinary retention (POUR), urinary-tract infection (UTI), surgical-site infection (SSI), sepsis, stress incontinence, emergency department (ED) visits, and rehospitalization.

Results/Outcomes: After propensity score matching, the mean age was 59±12 years and mean BMI 29±6 kg/m2. 83% were white and 7% were Hispanic. The most common indication for surgery was diverticular disease (69%) followed by colorectal cancer (38%). Results of the propensity score analysis are outline in Table 1. There were no differences between groups in terms of 90-day rates of sepsis, stress incontinence and emergency room visits (p>0.05). However, ureteral stent placement was associated with increased risk of ureteral or genitourinary injury, (RR 5.80 [95 % CI 2.97-11.3], p< 0.001), AKI (RR 1.70 [95 % CI 1.41-2.04], p < 0.001), VTE events (RR 1.53 [95 % CI 1.15-2.05] p=0.003), POUR (RR 1.59 [95 % CI 1.26-2.03] p< 0.001), UTI (RR 1.64 [95 % CI 1.36-1.98] p< 0.001), SSI (RR 1.22, 95 % CI 1.04-1.44] p= 0.016), and rehospitalization (RR 1.47 [95 % CI 1.10-1.98] p= 0.010).

Conclusion/Discussion: In this study, ureteral stenting during LAR was independently associated with significantly higher rates of ureteral injury, renal and thromboembolic complications, urinary morbidity, and postoperative infection, without any reduction in sepsis or healthcare utilization. These findings suggest that routine stent placement during minimally invasive procedures may expose patients to additional perioperative risk and should be reserved for select complex cases rather than applied universally.

Table 1
Propensity Matched Analysis of 90-day Outcomes: Effects of Ureteral Stent following Low Anterior Resection