Clinical significance of ureteral stent removal by flexible cystoscopy on pain and satisfaction in young males: a prospective randomised control trial

Introduction: Placement of a ureteral stent at the time of renal transplantation can reduce complications when compared to non-stented anastomoses. Removal by flexible cystoscopy can be associated with discomfort, risk for infection, and high costs. New magnetic stents offer a means of bypassing cystoscopy by use of a magnetic retrieval device. Our objective was to compare clinical and cost-related outcomes of conventional and magnetic stents in patients undergoing deceased donor renal transplantation. Methods: Patients were randomized to receive either a conventional or a Black-Star® magnetic stent. Clinical, procedural, and cost outcomes were assessed, and the Ureteral Stent Symptom Questionnaire (USSQ) was administered with the stent in situ and after stent removal. All variables were compared between groups. Results: Forty-one patients were randomized to conventional (n=19) or Black-Star (n=22) stent. The total time for stent removal under cystoscopy was significantly longer compared to Black-Star removal (6.67±2.47 and 4.80±2.21 minutes, respectively; p=0.019). No differences were found in the USSQ domains between groups. Rates of urinary tract infections and surgical complications between groups were similar. Stent removal was well-tolerated in both groups. Black-Star stent use resulted in a cost savings of $304.02 Canadian dollars (CAD) per case. Conclusions: USSQ scores suggest that stent removal with the Black-Star magnetic stent is as equally well-tolerated as flexible cystoscopy by renal transplant patients. Black-Star stent removal was significantly faster than conventional stents. No differences in discomfort, infection rate, or complication rate were found. Use of the Black-Star stent resulted in an estimated annual savings of $27 360 CAD at our centre.

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MP77-07 FLEXIBLE CYSTOSCOPY FOR URETERAL STENT REMOVAL WITHOUT ANTIMICROBIAL PROPHYLAXIS. A PROSPECTIVE OBSERVATIONAL STUDY

The Journal of Urology ◽

10.1097/01.ju.0000557319.54305.7e ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Author(s):

Alberto Olivero* ◽

Niccolò Ricciardi ◽

Drilona Ndrevataj ◽

Federica Balzarini ◽

Mattia Cerasuolo ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Antimicrobial Prophylaxis ◽

Ureteral Stent ◽

Flexible Cystoscopy ◽

Stent Removal

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Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study

European Urology Supplements ◽

10.1016/s1569-9056(19)33680-2 ◽

2019 ◽

Vol 18 (9) ◽

pp. e3276-e3277

Author(s):

D. Ndrevataj ◽

A. Olivero ◽

N. Riccardi ◽

F. Balzarini ◽

M. Cerasuolo ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Antimicrobial Prophylaxis ◽

Ureteral Stent ◽

Flexible Cystoscopy ◽

Stent Removal

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Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study

Urologia Journal ◽

10.1177/0391560320980897 ◽

2020 ◽

pp. 039156032098089

Author(s):

Alberto Olivero ◽

Niccolò Riccardi ◽

Drilona Ndrevataj ◽

Federica Balzarini ◽

Mattia Cerasuolo ◽

...

Keyword(s):

Risk Factors ◽

Observational Study ◽

Prospective Observational Study ◽

Antimicrobial Prophylaxis ◽

Asymptomatic Bacteriuria ◽

Ureteral Stent ◽

Flexible Cystoscopy ◽

Stent Removal ◽

Febrile Uti ◽

High Bmi

Objective: Flexible cystoscopy for ureteral stent removal after ureteroscopy is widely performed. In this scenario, the real need for antimicrobial prophylaxis is still uncertain. Aim of this study is to determine the urinary tract infections rate after 4 weeks from outpatient flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis. Patients and methods: A prospective observational study was performed between November 2017 and August 2018 in a single, high-volume Institution. Risk factors for UTIs were recorded. Immediately before cystoscopy, each patient submitted a voided urine specimen. Antibiotics were not given before or after cystoscopy. About 7 and 28 days after cystoscopy all the patients underwent abdomen US, urine analysis and culture, and clinical evaluation to assess possible symptoms of UTI. Results: A total of 192 patients were enrolled in the study, 76 patients (39.2%) were female. Median age was 55 years [IQR 47- 68]. Median BMI was 24.2 [22.9-26.7]. Eighteen patients (9.4%) had asymptomatic bacteriuria before cystoscopy and 39 (20.3%) had positive culture at 7 days. About 21 patients (10.9%) were diagnosed with febrile UTI in the 28 days FU period. The 28.6 % of the Febrile patients had asymptomatic bacteriuria before the stent removal ( p < 0.001), this group was slightly older ( p = 0.085) and with higher BMI ( p = 0.036). Forty-eight patients had positive urine culture at 7 days, of whom 27 (14.1%) were asymptomatic and were classified as asymptomatic bacteriuria. Multivariate analysis shows that only high BMI and bacteriuria before the procedure were significantly associated with developing a febrile UTI, none of the other risk factors was significant. Conclusion: Our data show a high rate of UTI after flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis especially in patients with asymptomatic bacteriuria, in those with high BMI and in the elderly; in these subgroups, antimicrobial prophylaxis should be recommended.

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A rare complication of ureteral stent removal: Answers

Pediatric Nephrology ◽

10.1007/s00467-021-05264-9 ◽

2021 ◽

Author(s):

Dorna Derakhshan ◽

Sahand Mohammadzadeh ◽

Ali Derakhshan ◽

Mitra Basiratnia ◽

M. H. Fallahzadeh

Keyword(s):

Rare Complication ◽

Ureteral Stent ◽

Stent Removal

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Magnetic Ureteral Stent Removal Without Cystoscopy: A Randomized Controlled Trial

Journal of Endourology ◽

10.1089/end.2017.0051 ◽

2017 ◽

Vol 31 (8) ◽

pp. 762-766 ◽

Cited By ~ 15

Author(s):

Marie-Claire Rassweiler ◽

Maurice-Stephan Michel ◽

Manuel Ritter ◽

Patrick Honeck

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Ureteral Stent ◽

Stent Removal ◽

Randomized Controlled

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A survey of adult and pediatric urologists on current practice in antibiotic prophylaxis for ureteral stent removal

Journal of Pediatric Urology ◽

10.1016/j.jpurol.2020.11.004 ◽

2020 ◽

Author(s):

Claudia Berrondo ◽

Jennifer J. Ahn ◽

Paul A. Merguerian ◽

Thomas S. Lendvay ◽

Margarett Shnorhavorian

Keyword(s):

Antibiotic Prophylaxis ◽

Current Practice ◽

Ureteral Stent ◽

Stent Removal

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PD9-10 TIMING OF URETERAL STENT REMOVAL AND POSTOPERATIVE COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY WITH URINARY DIVERSION

The Journal of Urology ◽

10.1016/j.juro.2015.02.937 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Justin Matulay ◽

Christopher Sayegh ◽

Julia Finkelstein ◽

Mark Silva ◽

G. Joel DeCastro

Keyword(s):

Postoperative Complications ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Ureteral Stent ◽

Stent Removal

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MP26-15 SYMPTOMATIC URINARY TRACT INFECTIONS IN RENAL TRANSPLANT PATIENTS AFTER CYSTOSCOPY FOR URETERAL STENT REMOVAL

The Journal of Urology ◽

10.1016/j.juro.2016.02.2952 ◽

2016 ◽

Vol 195 (4S) ◽

Author(s):

Justin Gregg ◽

Caroline Kang ◽

Thomas Talbot ◽

S. Duke Herrell ◽

Roger Dmochowski ◽

...

Keyword(s):

Urinary Tract ◽

Renal Transplant ◽

Urinary Tract Infections ◽

Ureteral Stent ◽

Stent Removal ◽

Transplant Patients ◽

Renal Transplant Patients ◽

Tract Infections

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Outcomes of Ureteral Stent Placement for Hydronephrosis in Patients with Gynecological Malignancies

Current Urology ◽

10.1159/000447165 ◽

2016 ◽

Vol 10 (3) ◽

pp. 126-131 ◽

Cited By ~ 2

Author(s):

Saya Kurata ◽

Shohei Tobu ◽

Kazuma Udo ◽

Mitsuru Noguchi

Keyword(s):

Radiation Therapy ◽

Stent Placement ◽

Poor Prognosis ◽

Ureteral Stent ◽

Ureteral Stents ◽

Ureteral Stenosis ◽

Stent Removal ◽

Gynecological Malignancies ◽

Lymph Node Swelling ◽

Observation Period

Objective: We examined the outcomes of patients undergoing ureteral stent placement for hydronephrosis that occurred during treatment for gynecological malignancies. Materials and Methods: From January 2004 to December 2009, we enrolled 33 patients with 45 ureters undergoing ureteral stent placement for hydronephrosis which occurred during treatment for gynecological malignancies. We examined the outcomes of the patients after stent placement. Results: The causes of hydronephrosis were obstruction of the urinary tract by a tumor (n = 22), obstruction due to lymph node swelling (n = 6), ureteral stenosis after radiation therapy (n = 4), and others (n = 1). The ureteral stent was inserted into both ureters in 12 cases, and into one ureter in 21 cases. Ureteral stents were replaced 1-26 times during the observation period (median 3 times). Eighteen (40%) ureteral stents were removed. The reasons for ureteral stent removal were hydronephrosis improvement (11 ureters, 24.4%), a change to nephrostomy (cystectomy: 1 ureter, progression of ureteral stenosis: 2 ureters), renal atrophy (3 ureters), and ureteral dilatation (1 ureter). All of the cases in which ureteral stent withdrawal due to hydronephrosis improvement were cases in which the ureter was compressed by a tumor and were lower ureteral obstructions. Twenty-one patients (64%) died due to cancer after stent placement. The periods from the first stent placement to death ranged from 1 to 58 months (median 18 months). Conclusion: Ureteral stent placement was associated with a poor prognosis in patients with gynecological malignancies. There were a few cases in which stent withdrawal became possible due to the improvement of hydronephrosis. In such cases, the withdrawal rate varied according to the cause and obstructive level.

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