Prophylactic ureteric catheterisation during complex gynaecological surgery: A systematic review and meta‐analysis

Abstract Background There is a lack of robust evidence to recommend the use of perioperative ureteric catheterisation or stenting in complex gynaecological surgery. Objectives To evaluate the evidence on the benefits and risks of perioperative ureteric catheterisation or stenting in complex gynaecological surgery. Search strategy A literature search was performed in CINAHL, the Cochrane Library, Embase and MEDLINE, from 1946 to January 2024, using a combination of keywords and Medical Subject Headings (MeSH) terminology. Selection criteria Randomised controlled trials (RCTs) and observational studies were included. Data collection and analysis Meta‐analysis of the RCTs and observational studies were performed separately. Cochrane RevMan 6.5.1 was used to undertake meta‐analysis. Risk ratios with 95% CIs were calculated for the outcome measures. Main results Ten studies were included: three RCTs and seven observational studies, comprising 8661 patients. The three RCTs, comprising a total of 3277 patients, showed no difference in the risk of immediate complications in the form of ureteric injury between the ureteric stent and the control groups (RR 0.9, 95% CI 0.49–1.65). The observational studies included 5384 patients. Four studies that explored the ureteric injury as an outcome did not show any difference between the two groups (RR 0.76, 95% CI 0.27–2.16). One case–control study with 862 participants found that the rate of ureteric injury was higher in the non‐stented group, although this was observed in only three patients. The risk of urinary tract infection (UTI) was increased in the stent group, although not with statistical significance (RR 1.84, 95% CI 0.47–7.17). There was no significant difference in the risk of ureteric fistulae (RR 1.91, 95% CI 0.62–5.83), although the number of studies was limited. Conclusions Prophylactic ureteric catheterisation or stenting for complex gynaecological surgery is not associated with a lower risk of ureteric injury.