title: Routine ureteric stenting before cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in managing peritoneal carcinomatosis from gynecologic malignancies: a single-center experience.
abstract: BACKGROUND
  Iatrogenic ureteric injury is a rare, yet serious operative complication in gynecologic procedures and associated with substantial morbidities such as prolonged hospitalization, additional financial-based ureter-related repairing procedures, impaired renal function, and compromised quality of life. Direct visual identification of ureters can be very challenging in managing patients with primary advanced or recurrent disseminated intraperitoneal gynecologic malignancies, who are referred to complex procedures such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
  
  
  OBJECTIVE
  To report our single-center experience (feasibility and morbidity) with prophylactic ureteric stents as a routine practice before CRS+HIPEC procedure in managing peritoneal carcinomatosis (PC) from gynecologic malignancies.
  
  
  METHODS
  From June-2010 to March-2014, all patients with gynecologic-related PC, managed with CRS+HIPEC, and underwent prophylactic ureteric stents. The data were retrospectively abstracted and analyzed.
  
  
  RESULTS
  Fifty-three patients were identified. Almost all PC cases were secondary/recurrence presentations (90.6 %) and originated from ovarian cancer (84.9 %). Optimal cytoreduction microscopic residual disease) was achieved in 35 patients (60 %). Average insertion time of ureteric stents was 8.9 ± 3.3 min. Fifty-two patients (98.1 %) received bilateral ureteric stents. Forty-nine patients (92.5 %) had their ureteric stents removed by the end of procedure. No patient experienced major peri-operative urinary tract-related complications.
  
  
  CONCLUSIONS
  Prophylactic ureteric stents appeared to be feasible, potentially safe, and could reduce the risk of iatrogenic ureteric injuries without incurring an increase in urinary tract-related complications. Prophylactic ureteric stenting does not eliminate the necessity for competent anatomical knowledge, meticulous retroperitoneal dissection and direct intra-operative visualization of ureters.
authors.affiliation: Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia.|King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.|College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Abu-Zaid
authors.affiliation: College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: H
authors.initials: H
authors.lastname: Abou Al-Shaar
authors.affiliation: King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.|Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: Azzam
authors.affiliation: Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia.
authors.forename: O
authors.initials: O
authors.lastname: AlOmar
authors.affiliation: Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: M F
authors.initials: MF
authors.lastname: Al-Otaibi
authors.affiliation: King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: T
authors.initials: T
authors.lastname: Amin
authors.affiliation: Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia. i_albadawi@yahoo.com.|College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. i_albadawi@yahoo.com.
authors.forename: I A
authors.initials: IA
authors.lastname: Al-Badawi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy; D010478:Chemotherapy, Cancer, Regional Perfusion; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D010051:Ovarian Neoplasms / Q000473:pathology / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cytoreductive surgery; Gynecologic surgery; Hyperthermic intraperitoneal chemotherapy; Ureter; Ureteric injury; Ureteric stenting