The outcomes of ureterolysis during complex rectovaginal endometriosis surgery in stented patients
BAUS ePoster online library. Mikhail M.
Jun 26, 2018; 211315
Mr. Michael Mikhail
Mr. Michael Mikhail
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Introduction: NICE guidance recommends multidisciplinary work for patients with complex rectovaginal endometriosis. Those with ureteric involvement may require ureterolysis, including stent insertion, following complex or extensive dissection. We aimed to determine the incidence of post-operative ureteric strictures in a 5-year endometriosis cohort.

Methods: 239 patients who underwent surgery for complex pelvic endometriosis from January 2011 to December 2015 were identified from our tertiary referral unit database. Pre-operative loin pain, hydronephrosis, intra-operative stenting and post-operative stent management were analysed. Fisher's Exact Test was used to determine significance.

Results: 85% of patients (203/239) did not require intraoperative stents. Of the 15% (36/239) who were stented, 22% (8/36) had pre-operative hydronephrosis, 22% (8/36) had loin pain and 14% (5/36) had both. There was a tendency towards a greater post-operative risk in stented patients (i.e “high risk” intraoperative cases) compared with unstented patients (p=0.07), but no difference in risk in patients whose stents were removed cystoscopically or after ureteroscopic assessment (p=1.0).

Conclusions: These data show a low overall risk of post-operative ureteric sequelae and support the conclusion that intra-operative stent insertion for “high risk” cases allows a similar outcome to less complex patients who did not need stents at all. Pre-operative loin pain / hydronephrosis increases the likelihood of needing intra-operative stents, and should be considered in operation scheduling. Post-operative ureteroscopic assessment does not appear to be needed. Instead, unless there are specific concerns, out-patient stent removal with a flexible cystoscope and early MAG3 renography seems sufficient for upper tract follow up.
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