Perioperative Complications and Omission of Ureteral Stents During Robot-Assisted Radical Cystectomy with Intracorporeal Ileal Conduit

Purpose: Ureteral stents are commonly placed intraoperatively during radical cystectomy, though their efficacy in reducing complications is unproven. We compared clinical outcomes among patients undergoing robot-assisted radical cystectomy with intracorporeal ileal conduit (RARC-IC) with or without ureteral stents to determine if omission of ureteral stents affects postoperative complications.

Materials and methods: All RARC-IC surgeries performed at our institution between November 2017 and June 2023 were reviewed. Beginning August 2021, ureteral stents were routinely omitted. Primary outcome was ureteroenteric anastomosis (UEA) complications (urine leak, urinary tract infection [UTI], abscess, and/or sepsis) within 30 and 90 days of RARC-IC. Secondary outcomes included rates of wound infections, urgent care center visits, inpatient readmissions, and ureteral stricture.

Results: Among 133 patients included, 90 patients (68%) received a ureteral stent and 43 (32%) did not. Composite UEA complications were higher in the stented group (20% vs 9.5%, 10% difference, 95% CI, -3.4%-24%, p = 0.2), though not statistically significant. The stented group had a significantly higher 30-day UTI rate (19% difference, 95% CI, 9.0%-29%, p = 0.007). The 30-day readmission rates were higher in the stented group, although differences did not meet statistical significance (19% vs 9.8%, 9.1% difference, 95% CI, -4.8%-23%, p = 0.3). Limitations include lack of randomization and inability evaluate some outcomes including, ureteral obstruction or strictures.

Conclusions: Omission of ureteral stent placement at RARC-IC is safe and feasible. Randomized trials are warranted to determine the effects of stents on risk of postoperative complications after RARC-IC.