Risk stratification of acute kidney injury (AKI) following ureteral stent insertion for colorectal surgery.

INTRODUCTION AND OBJECTIVES: Ureteral stents have long been utilized during colorectal resections to assist in the identification of ureters intraoperatively and mitigate risk of ureteral injury. As these procedures have shifted toward robot-assisted laparoscopic methods, lighted stents have increasingly been used. The incidence of acute kidney injury (AKI) following bilateral ureteral stent placement has been reported to be as high as 41.9%. We sought to identify our single-institution risk and determine the extent to which age, sex, and stent type affected incidence of AKI. METHODS: A retrospective analysis was performed at a single community hospital of all open and robotic-assisted laparoscopic colorectal surgeries from October 2012 to April 2022. If requested, ureteral stents were placed bilaterally by a urologist and later removed by the surgeon. Non-lighted stents used were 5 Fr whistle-tip (BARD); lighted stents were 6 Fr with a fiberoptic core (STRYKER). Kidney failure was described as a rise of creatinine to ≥ 1.5 times the preoperative value, per KDIGO guidelines. RESULTS: 633 consecutive colorectal surgeries were evaluated, with no stents placed in 237 cases, non-lighted stents placed in 137 cases, and lighted stents placed in 259 cases. No ureteral injuries were observed. Overall incidence of AKI for non-stented surgeries was 0.8% vs 5.8% for non-lighted stents and 5.8% for lighted stents. Patient age was the most significant factor in AKI incidence: for patients under 60, there was no statistical difference in AKI incidence for stented vs non-stented procedures (2.2% vs 1.1%). For patients over 60, the risk of AKI was 10.5% for stented vs 0.7% for non-stented. Female patients had statistically significant risk differences, with AKI incidence of 7.1% stented vs 0.0% non-stented. AKI completely resolved in all cases, regardless of cohort. CONCLUSIONS: In patients under age 60, the use of stents was not associated with an increased risk of AKI. For women and those over 60, stents pose a higher risk of transient AKI. Overall incidence of AKI in our larger and single-institution community hospital population was significantly lower than reported in other studies. No statistical difference was observed, overall, in AKI incidence between lighted and non-lighted stents.

Peyronie disease in younger men: characteristics and treatment results.

We retrospectively reviewed our experience with 30 men with Peyronie disease (PD) younger than age 40 years to describe their clinical presentation, physical examination findings, and treatment outcomes. In addition, we performed a literature review to define the typical patient with PD and to compare our findings with those in the literature. The mean age of our study population was 31 years (range 18-38 years). The prevalence of patients under the age of 40 presenting with PD was 1.5%. In this population, 97% reported normal erectile capacity, and 100% presented with a palpable plaque. Medical and surgical treatments were used in the young population with results comparable to published data. According to the published literature we reviewed, patients with PD were less likely to recall a specific traumatic event, less likely to complain of painful intercourse, they had different directions of penile curvature, and different locations of penile plaques. Younger men with PD commonly present with complaints and physical examination findings that differ from the typical patient with PD.