title: Urologic-Induced Complications of Prophylactic Ureteral Localization Stent Placement for Colorectal Surgery Cases.
abstract: OBJECTIVE
  A prophylactic ureteral localization stent (PULSe) placed by urologists aids in intraoperative localization and detection of suspected ureteral injury during complex colorectal surgery (CRS) cases. We evaluated the incidence and management of urologic-induced complications secondary to PULSe placement during CRS cases at a single center.
  
  
  METHODS
  We performed a retrospective review of all patients who underwent cystoscopy and PULSe placement at the time of CRS over a 12-month period. Bilateral 5 French ×70-cm TigerTail® (Bard Medical Division, Covington, GA) PULSe devices were placed without assistance of routine fluoroscopy.
  
  
  RESULTS
  Ninety-nine patients (mean age, 58.1 years; range, 17-88 years) underwent bilateral PULSe placement, with a male:female ratio of 44:55 and a mean body mass index of 26.8 (17.0-38.6) kg/m(2). Mean pre- and postprocedural creatinine levels were 0.91 and 1.01 mg/dL, respectively. Twenty-two of 99 (22%) cases utilized a guidewire to aid in placement of PULSe. Four Clavien grade IIIb complications occurred: mucosal edema, reflex anuria, ureteral perforation, and ureteral obstruction secondary to significant clot burden. Three of the grade IIIb complications were managed endoscopically with double-J stent placement. The ureteral perforation case required percutaneous nephrostomy tube placement. Subgroup analysis of the four grade IIIb complications revealed a mean age of 62.3 years, body mass index of 26.98 kg/m(2), and pre- and postprocedural creatinine levels of 0.95 and 4.83 mg/dL, respectively. Only one of the four grade IIIb complications utilized a guidewire prior to PULSe placement.
  
  
  CONCLUSIONS
  The incidence of Clavien grade III urologic-induced complications during PULSe placement is approximately 2% (4/188). Mandatory adoption of fluoroscopy and guidewires may be required to minimize complications of PULSe placement.
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Ram A
authors.initials: RA
authors.lastname: Pathak
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Abby S
authors.initials: AS
authors.lastname: Taylor
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Scott
authors.initials: S
authors.lastname: Alford
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Broderick
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Igel
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Petrou
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wehle
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Young
authors.affiliation: Department of Urology, Mayo Clinic , Jacksonville, Florida.
authors.forename: David D
authors.initials: DD
authors.lastname: Thiel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery; D003558:Cystoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D014513:Ureter / Q000293:injuries*; D014517:Ureteral Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D055815:Young Adult