title: Minimizing complications during retropubic radical prostatectomy - Is ureteral stenting necessary?
abstract: OBJECTIVE
  To avoid damage to the ureters during bladder neck preparation in radical prostatectomy for prostate cancer, it may be helpful to insert ureteral stents temporarily or to intravenously administer indigo carmine dye for enhanced visualisation of ureteric orifices. We evaluated our bladder neck preserving technique at radical prostatectomy with regard to ureteric injuries.
  
  
  METHODS
  We analysed 369 consecutive radical prostatectomies operated in our clinic in a bladder neck preserving technique. The following parameters were assessed in this retrospective study: number of prophylactic ureteric stent insertions, application of indigo carmine dye, observed injuries of the ureters by the surgeon, postoperative increase of serum creatinine and postoperative status of kidney ultrasound.
  
  
  RESULTS
  In 7/369 prostatectomies (1.90%) a ureteric stent insertion was performed, indigo carmine was not applied to any patient at all, yet no intraoperative injury of a ureter was observed by a surgeon. No revision was necessary due to a ureteral injury within the observation period of one year after surgery. In 17 patients with preoperative normal creatinine value a pathological value was observed on the first postoperative day (mean 1.4 mg/dl). In these patients no consecutive postrenal acute renal failure was observed, no hydronephrosis was monitored by ultrasound and no further intervention was necessary.
  
  
  CONCLUSIONS
  Bladder neck preserving operation technique does not implicate the need of prophylactic ureteric stent insertions and has no higher incidence of ureteric injuries.
authors.affiliation: Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Germany. boris.schlenker@med.uni-muenchen.de
authors.forename: B
authors.initials: B
authors.lastname: Schlenker
authors.forename: C
authors.initials: C
authors.lastname: Gratzke
authors.forename: M
authors.initials: M
authors.lastname: Seitz
authors.forename: P
authors.initials: P
authors.lastname: von Walter
authors.forename: D
authors.initials: D
authors.lastname: Tilki
authors.forename: O
authors.initials: O
authors.lastname: Reich
authors.forename: D
authors.initials: D
authors.lastname: Zaak
authors.forename: C G
authors.initials: CG
authors.lastname: Stief
authors.forename: M J
authors.initials: MJ
authors.lastname: Bader
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D014513:Ureter / Q000293:injuries / Q000473:pathology / Q000601:surgery*
references.citation: Urology. 1994 Feb;43(2 Suppl):47-51
references.pmid: 8116133
references.citation: J Urol. 1992 Mar;147(3 Pt 2):883-7
references.pmid: 1538489
references.citation: Ann Oncol. 2005 Mar;16(3):481-8
references.pmid: 15718248
references.citation: Eur J Med Res. 2009 Jul 22;14(7):292-6
references.pmid: 19661011
references.citation: Eur Urol. 1999;35(3):210-6
references.pmid: 10072622
references.citation: J Natl Cancer Inst. 2008 Aug 20;100(16):1144-54
references.pmid: 18695132
references.citation: J Urol. 1949 Sep;62(3):340-8
references.pmid: 18148289
references.citation: J Urol. 1982 Sep;128(3):492-7
references.pmid: 7120554
references.citation: J Urol. 2004 Dec;172(6 Pt 1):2145-52
references.pmid: 15538220
references.citation: World J Urol. 2003 Aug;21(3):139-43
references.pmid: 12898171
references.citation: Eur Urol. 2008 Jan;53(1):68-80
references.pmid: 17920184
references.citation: Urology. 2003 Oct;62(4):702-6
references.pmid: 14550447
references.citation: J Urol. 1987 Jun;137(6):1189-91
references.pmid: 3586152
references.citation: Urol Clin North Am. 2001 Aug;28(3):639-53
references.pmid: 11590819
references.citation: J Urol. 2009 Sep;182(3):956-65
references.pmid: 19616252
references.citation: Eur Urol. 2007 Jan;51(1):90-7
references.pmid: 17074431
references.citation: J Clin Oncol. 2007 Jan 1;25(1):91-6
references.pmid: 17194909
references.citation: J Urol. 1999 Aug;162(2):433-8
references.pmid: 10411052
references.citation: Urologe A. 1995 Jul;34(4):334-42
references.pmid: 7545846