the reported incidence of ureteral injury during colorectal surgery has ranged from 0.2 to 4.5 % .
the use of prophylactic lighted ureteral stent ( lus ) placement has gained more importance with the advent of laparoscopic colectomy .
lighted stents help in the visual identification of the ureters during a laparoscopic procedure . despite the apparent advantages of prophylactic ureteral stent placement , its effectiveness is still controversial .
injury to the ureters in spite of stent placement , hematuria , and reflux anuria have also been reported .
we report here our experience with prophylactic placement of lighted ureteral stents during laparoscopic colectomy and discuss the value and the outcomes of this procedure .
a retrospective analysis was done of 66 patients who underwent laparoscopic colectomy ( lco ) with preoperative placement of lus at north oakland medical centers , pontiac , michigan , between april 1996 and january 2000 .
the catheter used was a polyurethane bard 6 lighted ureteral catheter. the parameters evaluated included age and sex of patients , the indication for surgery , the location of the pathology , the presence or absence of preoperative urinary tract symptoms .
the urologic operative reports were reviewed for pathology identified during cystoscopy and ureteral catheterization , duration of the procedure , uni - lateral or bilateral placement of the catheters , and the size of the ureteral catheter used .
complications related to ureteral catheter insertion , timing of catheter removal , intraoperative ureteral injury , occurrence of postoperative urinary tract infection , hematuria , and reflux anuria were also reviewed .
operating room charges were also considered along with a comparison of the complications between unilateral and bilateral stent placement .
of the 32 male patients , 3 ( 9.4% ) had a history of urinary frequency and 4 ( 12.5% ) had a history of dysuria .
the urologic reports for pathology identification , duration of the procedure , and the side of catheter insertion are described in table 3 .
urinary tract infection ( uti ) was assessed with the urine culture reports postoperatively . in spite of the ureteral catheterization ,
1 patient suffered an incomplete left ureteral injury during sigmoid colectomy , which was managed conservatively with the reinsertion of a left ureteral stent .
the complications following unilateral stenting and bilateral stenting were compared as illustrated in figure 1 .
the duration of hematuria ( days ) poststenting between patients who had unilateral ( 2.5  0.82 ) and bilateral ( 3.37  1.05 ) stent placement was statistically significant with p < 0.001 .
the cost involved in stent placement included $ 1504.32 with an average increase of 26 minutes in operating room time costing $ 578 , the urologist 's charges of $ 452.72 , and each stent costing $ 236.80 .
the total percentage of patients with unilateral and bilateral stenting with complications is depicted in the figure .
the usefulness and outcomes of prophylactic ureteral stenting during open colorectal surgery has been well documented in the literature .
ureteral catheter placement allows intraoperative tactile localization of the ureters and is helpful in immediate recognition of ureteral injuries . with the introduction of laparoscopic colectomy as an alternative for traditional colorectal surgery ,
the placement of lus during laparoscopic colectomy has gained more importance because of visual identification of the ureters .
, we evaluated the value of prophylactic placement of lighted ureteral stents in laparoscopic colectomy .
the majority of our patients had bilateral stents placed initially . as the surgeons gain more experience , the number of stents placed depends on the location of the pathology and the surgeon 's preference .
ureteral injuries during laparoscopic colectomy have occurred and have also been reported during laparoscopic hysterectomy .
ureteral injuries are of 4 types : laceration , ligation , crush , and devascularization . these injuries may be detected either intraoperatively or postoperatively .
the placement of prophylactic ureteral stents helps in detecting the ureteral injuries intraoperatively and adequate action to be taken immediately .
this injury was recognized on postoperative day 2 with urinary ascites and was managed by reinserting the left ureteral stent temporarily .
the placement of ureteral catheters results in postoperative gross hematuria in almost all the patients .
overall , this hematuria is of no clinical significance as no blood transfusion is required . on the other hand ,
anuria is suggested to be the result of neurogenic factors initiated by ureteral manipulation and mediated through the autonomic nervous system .
studies have demonstrated that anuria after ureteral catheterization is due to edema which causes mechanical obstruction at the ureterovesical junction .
recognition of this symptom , which usually requires repeated ureteral catheterization , is important . in our series , 4 ( 6.1% )
it is possible that the 2 patients who had acute renal failure could have benefited from repeated ureteral stenting .
the incidence of urinary tract infections was acceptable and in most cases was not troublesome .
it may be attributable to the postoperative foley catheter that these patients received rather than the ureteral stents .
we conclude that prophylactic lighted ureteral catheter placement in laparoscopic colectomy is a safe and cost - effective procedure .
unilateral stent placement is recommended over bilateral stent placement to reduce operative time and postoperative hematuria .
 objective : the placement of indwelling ureteral catheters during colorectal surgery has been recommended for prevention of ureteral injuries . with the advent of laparoscopic colectomy ( lco ) , 
 the role of preoperative placement of lighted ureteral stents ( lus ) has also become commonplace . 
 we sought to evaluate the value of lighted ureteral stent placement in laparoscopic colectomy.methods:sixty-six patients underwent lco with lus inserted preoperatively . 
 stents were removed in the immediate postoperative period . 
 two surgeons performed all the colectomies ; 32 patients were males and 34 were females . 
 fifty patients underwent sigmoid colectomy , 4 had abdominoperineal resection , 4 had right colectomy , and 1 each had transverse or subtotal colectomy . 
 eighteen patients had a diagnosis of cancer , 34 had diverticular disease , and 14 had neoplastic polyps . 
 forty patients had bilateral and 26 had unilateral stent placement . 
 a review of the incidence of ureteral injuries , hematuria , and anuria as the cause of acute renal failure was accomplished , comparing the unilateral and bilateral stented groups.results:one ( 1.5% ) patient suffered a left ureteral laceration during sigmoid colectomy . 
 this was managed successfully with stent reinsertion . 
 sixty - five ( 98.4% ) patients had gross hematuria lasting 2.93 days ( 1 to 6 days ) . 
 the cost of bilateral stent placement was $ 1504.32 . 
 a statistically significant difference occurred in the duration of hematuria ( days ) between patients who had unilateral ( 2.5  0.82 ) and bilateral stent placement ( 3.37  1.05 ) , ( p < 0.001 ) . 
 four patients suffered from anuria , 2 required renal support needing hemodialysis for 3 to 6 days , 3 ( 75% ) had bilateral stents , and 1 ( 25% ) had a unilateral stent.conclusions:we recommend the placement of lighted ureteral stents as a valuable adjunct to laparoscopic colectomy to safeguard ureteral integrity . 
 transient hematuria is common but requires no intervention . 
 reflux anuria occurs infrequently and is reversible . 
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION