Prophylactic ureteral stenting during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Impact on symptomatic ureteral events requiring renal drainage.

BACKGROUND

Ureteral injury during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an uncommon but serious complication. The value of prophylactic ureteral stenting remains uncertain.

METHODS

This retrospective monocentric study included patients with Peritoneal Surface Malignancies (PSM) undergoing CRS-HIPEC with ureterolysis and pelvic peritonectomy between 2015 and 2025. Patients were divided according to prophylactic ureteral stent placement. The primary endpoint was the occurrence of a symptomatic ureteral event, defined as a postoperative ureteral fistula or stricture requiring renal drainage. Secondary outcomes included chronic urinary diversion, overall urologic morbidity, and identification of predictive factors associated with ureteral complications.

RESULTS

Among 122 patients, 34 received a prophylactic stent and 88 did not. Symptomatic ureteral events requiring drainage occurred in 14/34 (41.2%) in the STENT group and 31/88 (35.2%) in the No STENT group. Ureteral fistulas occurred in 3/34 (8.8%) versus 15/87 (17.2%) respectively. Postoperative renal drainage occurred in 12/34 (35.3%) in the STENT group, and 30/87 (34.5%) in the No STENT group. Chronic urinary diversion was more frequent among stented patients 13/34 (38.2%) vs 18/88 (20.5%). No significant difference was observed between groups. Prior Surgical Score, Performance status, rectal resection and history of previous pelvic surgeries were associated with increased urologic morbidity.

CONCLUSIONS

Prophylactic ureteral stenting during CRS-HIPEC did not reduce symptomatic ureteral events requiring renal drainage. The stent group showed a trend toward increased chronic urinary diversion. These findings support a selective, risk-based approach based on patient characteristics and surgical complexity.