Prophylactic ureteral stenting in open surgery for deep pelvic malignancies: A simple step to enhance hemostasis

Abstract Background Iatrogenic ureteral injury (IUI) is a severe complication in surgery for deep pelvic malignancies. The utility of prophylactic ureteral stenting (PUS) to mitigate this risk remains controversial. This study aimed to prospectively evaluate the clinical value of PUS on intraoperative outcomes, including ureteral injury rates, blood loss, and the ease of surgical dissection and repair. Methods A retrospective review of 108 patients undergoing open surgery for deep pelvic malignancies. Patients were divided into two groups: the PUS group (n = 56), who received a preoperative ureteral stent, or the non-stented control group (n = 52). The primary outcome was the incidence of IUI. Secondary outcomes included operative time, estimated intraoperative blood loss, and postoperative complications. Data were analyzed using t-tests and Chi-square tests, with p < 0.05 considered significant. Results IUI was identified in 20/56 (35.7%) patients in the PUS group and 10/52 (19.2%) in the non-stented group. All injuries in the PUS group were identified and repaired intraoperatively. The PUS group demonstrated significantly lower mean intraoperative blood loss than the non-stented group (823.21 vs. 1232.08 ml; p = 0.002). There was no significant difference in mean operative time between the groups (241 min vs. 237 min; p = 0.769). The stented group also had significantly fewer patients with positive lymph nodes (p = 0.009) and required less adjuvant therapy (p = 0.0006), suggesting baseline differences in case complexity. Conclusion Prophylactic ureteral stenting did not reduce the incidence of iatrogenic ureteral injury; a higher injury rate was observed in the stented group, likely reflecting a selection bias for higher-risk cases. However, PUS was associated with a significant reduction in intraoperative blood loss and facilitated immediate injury recognition and repair. These findings support a selective, rather than routine, application of PUS, reserving it for patients with complex pelvic anatomy where ureteral identification is anticipated to be challenging. Clinical Trials registration number is NTC05183334