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

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.

Download Full-text

Urinary tract infections after endoscopic ureteral stent removal with and without antimicrobial prophylaxis: Preliminary results of a prospective observational study

European Urology Supplements ◽

10.1016/s1569-9056(19)33091-x ◽

2019 ◽

Vol 18 (7) ◽

pp. e2926

Author(s):

S. Parodi ◽

R. Malinarich ◽

A. Olivero ◽

P. Bottino ◽

C. Terrone

Keyword(s):

Urinary Tract ◽

Observational Study ◽

Urinary Tract Infections ◽

Prospective Observational Study ◽

Antimicrobial Prophylaxis ◽

Ureteral Stent ◽

Preliminary Results ◽

Stent Removal ◽

Tract Infections

Download Full-text

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

Urolithiasis ◽

10.1007/s00240-015-0833-x ◽

2015 ◽

Vol 44 (4) ◽

pp. 367-370 ◽

Cited By ~ 4

Author(s):

Young Beom Jeong ◽

A Ram Doo ◽

Hyung Sub Park ◽

Yu Seob Shin

Keyword(s):

Clinical Significance ◽

Ureteral Stent ◽

Randomised Control Trial ◽

Young Males ◽

Flexible Cystoscopy ◽

Stent Removal

Download Full-text

Comparison of a magnetic retrieval device vs. flexible cystoscopy for removal of ureteral stents in renal transplant patients: A randomized controlled trial

Canadian Urological Association Journal ◽

10.5489/cuaj.6684 ◽

2020 ◽

Vol 15 (2) ◽

Author(s):

Anil Kapoor ◽

Jason Akerman ◽

Emily Wong ◽

Gaurav Vasisth ◽

Fadil Hassan ◽

...

Keyword(s):

Renal Transplantation ◽

Renal Transplant ◽

Controlled Trial ◽

Ureteral Stent ◽

Flexible Cystoscopy ◽

Stent Removal ◽

Transplant Patients ◽

Renal Transplant Patients ◽

Tract Infections ◽

Retrieval Device

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.

Download Full-text

Distraction Reduces the Sensation of Pain on Flexible Cystoscopy: A Prospective Observational Study

Journal of Reconstructive Urology ◽

10.5336/urology.2020-77886 ◽

2020 ◽

Vol 10 (2) ◽

pp. 56-60

Author(s):

Murat TÜKEN ◽

Mithat EKŞİ ◽

Yusuf ARIKAN ◽

Osman ÖZDEMİR ◽

Deniz Noyan ÖZLÜ ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Flexible Cystoscopy

Download Full-text

A prospective observational study on the utility of smartphone-based Ureteral Stent Tracker (UST) application in preventing cases of forgotten ureteral double-J stents

Archives of International Surgery ◽

10.4103/ais.ais_41_20 ◽

2020 ◽

Vol 10 (3) ◽

pp. 86

Author(s):

S Sengupta ◽

S Basu ◽

K Ghosh

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Ureteral Stent

Download Full-text

Periprocedural Testing and Antimicrobial Prophylaxis for Ureteral Stent Removal: An Opportunity for Antimicrobial Stewardship

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.52 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s29-s29

Author(s):

Dhatri Kotekal ◽

Michelle Hecker ◽

Irma Lengu ◽

Andrea Son

Keyword(s):

High Risk ◽

Antimicrobial Prophylaxis ◽

Low Risk ◽

Ureteral Stent ◽

Positive Urine Culture ◽

Future Studies ◽

High Risk Patients ◽

Stent Removal ◽

Risk Patients ◽

Urine Testing

Background: The American Urologic Association’s 2019 Best Practices Statement highlights the importance of procedural and host factors in optimizing antimicrobial prophylaxis for urologic procedures. For ureteral stent removal, a procedure considered low risk, the recommendation for prophylaxis is uncertain and is dependent primarily on patient factors. We examined periprocedural practices and outcomes for both low-risk and intermediate- to high-risk patients undergoing this procedure in a county hospital. Methods: A retrospective cohort study was performed on all patients who underwent stent removal from January to December 2019. Patients were classified as being low risk if they met the following criteria: age 48 hours within the previous 30 days, absence of external urinary catheters, no intermittent catheterization, absence of prosthetic cardiac valves, not pregnant, and not immunocompromised. All other patients were classified as intermediate to high risk. We assessed periprocedural urine testing, antimicrobial prophylaxis, and clinical outcomes. Results: Of 158 unique patients, 84 (53%) were classified as low risk. As shown in Table 1, preprocedural urine cultures were performed in 55% of low-risk versus 69% of intermediate- to high-risk patients. For the patients for whom urine cultures were performed, cultures were positive in 22% of low-risk versus 55% of intermediate- to high-risk patients (p < .0001). All patients received antimicrobial prophylaxis, most often a single dose after the procedure. None of the low risk patients had a positive urine culture or hospitalization within 30 days post procedure. Conclusions: Overall, 53% of patients undergoing stent removal were considered low-risk hosts, yet 100% of patients received antimicrobial prophylaxis. Future studies are needed to evaluate interventions to reduce unnecessary antimicrobial prophylaxis and standardize preprocedural testing in low-risk patients undergoing stent removal.Funding: NoDisclosures: None

Download Full-text