To determine the effect of prophylactic ureteral catheterization (PUC) on kidney function in patients undergoing complex pelvic surgery and to determine if capping the stent increases that risk.

Design:

Single-center retrospective cohort study

Setting:

Large academic institution

Patients or Participants:

All patients aged 18 years or older who underwent complex pelvic surgery from Jan 2020 to March 2023 with PUC using 5 French catheters.

Interventions:

Prophylactic ureteral catheterization was performed prophylactically. Kidney function was measured. Two arms were considered, based on catheters being “capped” or not, to allow for ICG identification intraoperatively. Primary Outcome was the rate of acute kidney injury (postoperative increase in creatinine ≥0.3 mg/L)

Measurements and Main Results: 113 patients were included. The average age was 53 years (SD 14), and the mean body mass index was 30 kg/m² (SD 7.4). Among the subjects, 38% were of white ethnicity, 25% were black. In 58% of cases, indocyanine green (ICG) was injected into the catheters and capped for the duration of the surgery. 17% of patients were diabetic while 52% were hypertensive. 31 patients had cancer. The median surgical duration was 192 minutes, with a range of 137 to 237 minutes (IQR). Median blood loss during surgery amounted to 75 [137-237] mls. There were no cases of ureteral injury. Acute kidney injury was observed in 23 patients, accounting for 20.3% of the cohort. After adjusting for significant variables (age, sex, BMI, duration of surgery and baseline creatinine) capping of the ureteral stent was not independently associated with AKI, OR= 1.97 (0.44-8.7), P = 0.37.

Conclusion:

While PUCs assist with identification of ureters during complex pelvic surgery, they also entail risks of acute kidney injury (AKI). Surgeons should assess and balance carefully the potential advantages and disadvantages. Capping of the stents temporarily was not independently associated with AKI in our cohort.