Retrograde intraureteral injections of indocyanine green versus ureteral stents to reduce urinary tract complications during pelvic surgery: Systematic review and meta-analysis
Abstract
INTRODUCTION
Failure to successfully delineate ureters during pelvic surgery carries significant risks. The ureters are the most commonly injured retroperitoneal structures, and ureteral injuries are associated with prolonged hospital stays, higher health care costs, and increased morbidity. In this meta-analysis, we compared the retrograde ureteral injection of indocyanine green and ureteral stents to visualize ureters and prevent ureteral injury and other urinary tract complications during pelvic surgery.
METHODS
Thorough reviews of PubMed, Embase, and Scopus were conducted to identify all studies evaluating the efficacy of retrograde ureteral indocyanine green injections and/or ureteral stents for ureteral injury prevention. Strict inclusion criteria were applied, incorporating a Modified Downs and Black Assessment score. Because no studies comparing these 2 approaches directly were identified, indirect comparisons were performed contrasting rates of successful stent or indocyanine green placement, ureteral injury, and urinary tract complications, including the Pearson χ2 or Fisher exact test and odds ratios with 95% confidence intervals.
RESULTS
Twenty and 17 studies were eligible for meta-analysis for stents and indocyanine green, encompassing 25,784 and 569 patients, respectively. All 1,009 ureters that were injected with indocyanine green were injected successfully versus the successful insertion of only 99.1% of the 5,202 ureteral stents for which this approach was…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 25,784 participants or records.
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