title: A randomized controlled trial comparing simultaneous intra-operative vs sequential prophylactic ureteric catheter insertion in re-operative and complicated colorectal surgery.
abstract: OBJECTIVE
  Prophylactic insertion of ureteric stents aids intra-operative identification of ureters and may allow easier visualization of any direct ureteric injury. Traditionally, ureteric catheters are inserted sequentially, before starting the abdominal part of the operation. This study determines the safety and efficacy of simultaneous intra-operative ureteric catheter insertion during complicated and re-operative colorectal surgery.
  
  
  METHODS
  After institutional review board (IRB) approval, 24 patients were randomized into two groups, sequential (SEQ) and simultaneous (SIM) depending upon the timing of stent placement relative to abdominal incision. Time taken from induction to abdominal incision (AIT), induction to peritoneal entry (PET), catheter insertion time (CIT), and urinary tract infection rates were recorded. Degree of difficulty for stent insertion was graded on a scale of 1-10.
  
  
  RESULTS
  Demographics were similar between groups. Mean AIT (22 +/- 4 vs 41 +/- 7; p = 0.0001) and mean PET (26 +/- 4.2 vs 44 +/- 7.6; p = 0.0001) were shorter in the SIM group. There was no significant difference in mean CIT in SIM and SEQ groups (17.9 +/- 4.9 vs 17.6 +/- 5.9 min, p = 0.8). The stents were unsuccessful bilaterally in one patient in the SEQ group and unilaterally in two other patients, one in each group. The median difficulty score for catheter insertion was 3 (1-10) and 2 (1-10), (p = 0.12), respectively, in SIM and SEQ groups. There were no ureteric injuries in either group. One patient in SIM developed a urinary tract infection.
  
  
  CONCLUSIONS
  Simultaneous ureteric catheter insertion during abdominal procedures reduces operating times without a significant increase in morbidity. Furthermore, this permits a policy of selective stent insertion as required by the intra-abdominal findings after laparotomy.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Naveen
authors.initials: N
authors.lastname: Pokala
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Jane
authors.initials: J
authors.lastname: Bast
authors.forename: Kenneth
authors.initials: K
authors.lastname: Angermeier
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
mesh_terms: D000328:Adult; D003107:Colorectal Surgery / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D014546:Urinary Catheterization / Q000379:methods*