Placebo medications and sham surgeries have long been thought to be inert treatments. These groups served as a threshold to which an active treatment should be compared in a randomized trial to determine the true efficacy of the active treatment. However, surprising changes in subjective symptom scores and objective measures of voiding have been demonstrated in numerous placebo medication or sham surgery arms of trials. The exact mechanisms by which these inactive treatments augment patient outcomes are not clearly defined and multiple theories have been proposed to explain the often pronounced response. It appears that urologic outcomes are particularly prone to these effects and the astute physician should keep these responses in mind when interpreting any trial on a new therapy.

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Current American Urological Association (AUA) guidelines recommend antibiotic prophylaxis in patients undergoing cystoscopy with manipulation (including ureteral stent removal). However, there is little evidence that this practice prevents UTI. Our objective was to investigate current practice patterns of urologists in the use of antibiotic prophylaxis prior to ureteral stent removal.METHODS: An anonymous online survey was distributed to members of the Endourological Society. The survey included questions about provider demographics, personal practice for ureteral stent use and removal, and antibiotics prophylaxis prior to stent removal.RESULTS: Of the 2,544 urologists invited to participate, 284 (11%) completed the survey. Demographic information is outlined in Table 1. Half do not prescribe antibiotics while the stent is in place. Of those who give antibiotic prophylaxis before stent removal, 52% prescribe a single dose. There is variation in antibiotic prophylaxis by method of stent removal and surgery leading to stent placement (Figure 1). Forty-three percent do not obtain a urine culture (UC) prior to stent removal. For those who obtain a UC, duration of antibiotic treatment varies based on UC results (Figure 2). Main factors influencing practice are AUA guidelines, personal experience, patient history of UTI and UC results.CONCLUSIONS: There is significant variation in practice among urologists regarding antibiotic prophylaxis prior to stent removal. Without evidence to support this practice, patients may be exposed unnecessarily to harm related to antibiotic use without a clear benefit. This lack of consensus highlights the need for additional research and development of guidelines.