The impact of intraoperative ureteral stent omission on postoperative complications during radical cystectomy

Ureteral stents are traditionally placed intraoperatively during radical cystectomy (RC) to optimize healing and avoid short and long-term complications. However, strong evidence supporting this practice is lacking. We aim to assess the impact of ureteral stent placement with postoperative complications following RC.

The National Surgical Quality Improvement Program database included 4,375 patients who underwent RC from 2019 to 2021. Baseline characteristics and complication rates were stratified by utilization of ureteral stenting. Primary endpoints included 30-day complications, length of stay (LOS), and readmissions. Multivariable analyses was performed to determine the association of no stent placement with postoperative morbidity.

Of the 4,375 patients who underwent RC, 413 (9.4%) did not receive intraoperative stent placement. Patients without stent placement had lower ASA (ASA < 3: 21% v. 27%; p < 0.01), lower median BMI 27 v. 28; p < 0.01), and lower median operative times (292 min v. 322; p < 0.01). There was no difference in preoperative median estimated glomerular filtration rate (CKD-EPI creatine Eq. 2021) between patients with or without stents placed (70 mL/min/1.73m² v. 71 respectively; p = 0.8). Patients without stent placement had similar median LOS (6 days v. 6 days; p = 0.34) and readmission rates (23% v. 21%; p = 0.43) compared to those who had stents placed. After controlling for potential confounders, RC without stent placement was not associated with increased rates of any complication (OR: 1.23; 95% CI [0.99-1.51]), renal failure (OR: 1.4 [0.77-2.54]), ureteral stricture (OR: 0.6 [0.29-1.24]), urine leak (OR: 1.54 [0.91-2.62]), or UTI (OR: 1.18 [0.79-1.72]) at 30 days postoperatively.

The omission of ureteral stents in a select population of patients did not appear to increase the risk of morbidity including 30-day complications, postoperative renal failure, UTI, urine leak, or ureteral strictures, indicating stentless RC may be performed safely in select patients.