Laura Bradney, MD, Riva Das, MD, Andrea Ferrara, MD. Colon and Rectal Clinic of Orlando
Iatrogenic injury to the ureter during minimally invasive colon and rectal surgery can be a detrimental complication. The advent of lighted ureteral stents (LUS) has aided in the identification and protection of the ureters in such cases. LUS help replace the tactile feedback that is possible in open abdominal surgeries.
This is a case of a 43-year-old male who underwent an elective prophylactic robotic total abdominal colectomy with ileorectal anastomosis for attenuated polyposis syndrome. A cystoscopy was performed by urology prior to the start of the procedure for elective placement of LUS. A right single ureteral orifice was identified, but on the left there were two ureteral orifices consistent with a duplicated urinary system. This is a congenital malformation in which the ureteric bud splits leading to two ureters draining a single kidney. It occurs in approximately 1% of the population. Two fiberoptic LUS were placed, one on the right and one on the left. The medial ureter on the left received a non-lighted stent. During the left-sided colonic dissection, both the non-lighted stent and the LUS were easily identified, and the ureters were protected throughout the procedure. The stents were removed at the end of the case. The patient progressed appropriately and was discharged from the hospital with no urologic complaints.
Although the recommendation for routine use of prophylactic ureteral stents is an area of debate in colon and rectal surgery, they have proven to be useful for timely identification of the ureter, immediate identification of an iatrogenic ureter injury, and identification of ureter pathology (duplication in this case) all of which can lead to cost effectiveness. In this particular case, the use of prophylactic LUS allowed for the identification of aberrant anatomy and subsequent protection of the ureters in a patient that would presumably be at higher risk for ureteral injury.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93617
Program Number: V338
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop