Current Status of Ureteral Stent Technologies: Comfort and Antimicrobial Resistance

Méndez-Probst, Carlos E.; Fernandez, Alfonso; Denstedt, John D.

doi:10.1007/s11934-010-0091-y

Cited by 20 publications

(10 citation statements)

References 55 publications

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“…Use of antibiotic–releasing biomaterials has additional advantages, as they deliver the drug to target tissues and have a positive impact on both effectiveness (influencing directly the biofilm that is often resistant to systemic antibiotic therapy) and lowering the risk of systemic side effects. Additionally, it is suggested that increase in patient’s fluid intake, augmentation of urine pH value (via citrate consumption), analgesics, anticholinergics, alpha–blockers, and/or prophylactic antibiotic therapy may decrease the rate of complications or minimize the complaints [5]. Unfortunately, none of the above–described strategies has the power to fully prevent catheter colonization, so there is a need for further investigations and technological innovations in this field.…”

Section: Discussionmentioning

confidence: 99%

“…Sporadically, stent dislocation or fragmentation and even fistulas may occur. Forgotten stents should also be mentioned as they may result in serious complications such as marked incrustation, stent fragmentation, urosepsis, or even renal failure [1–5]. It must be, however, underlined that bacterial or fungal colonization of both catheter surface and urine is the most frequent complication that is noted.…”

Section: Introductionmentioning

confidence: 99%

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Rate of positive urine culture and double–J catheters colonization on the basis of microorganism DNA analysis

Kliś

Szymkowiak

Madej

et al. 2014

CEJU

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IntroductionThe aim of the trial was to estimate the relationship between colonization of the Double–J catheter, and the microorganisms cultured from urine.Material and methods60 patients, who had Double–J catheters inserted, participated in the study. All the subjects had their midstream urine samples taken prior to the stent insertion and removal. A negative urine culture before catheterization was mandatory to participate in the study. The patients were assigned into three subgroups, according to stenting duration: 1) 20 to 30 days (18 cases); 2) 30 to 90 days (30 cases); 3) longer than 90 days (12 cases). Bacterial and fungal DNA was identified using electrophoresis in polyacrylamide gel with a denaturing gradient (PCR–DGGE). The relationship between the genetic analysis of the catheter and the urine culture was estimated.ResultsUrine cultures were positive in only 8 patients, while Double–J catheter analyses were positive in all cases. In 2 cases one type of microorganism was isolated from the stent surface while the remaining 58 catheters were colonized by more than one pathogen. In three cases fungi were isolated. There were only three types of pathogens cultured from urine specimens. Urine and stent cultures were consistent in 5 cases. In 3 cases urine culture and stent analysis were not consistent.ConclusionsDouble–J catheter retention in the urinary tract is associated with an extremely high risk of bacterial colonization, while the risk of urine infection is about 8–fold lower. There is a great inconsistency between urine infection and catheter colonization, indicating a low predictive value of urine culture for estimating stent colonization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rate of positive urine culture and double–J catheters colonization on the basis of microorganism DNA analysis

Kliś

Szymkowiak

Madej

et al. 2014

CEJU

View full text Add to dashboard Cite

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“…Quantitative variables were expressed as mean and SD. In the analysis of risk factors for MDR, the comparison between groups for categorical variables was estimated by using χ 2 …”

Section: Methodsmentioning

confidence: 99%

Urinary Infections in Patients with Catheters in the Upper Urinary Tract: Microbiological Study

et al. 2017

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Background: Infections related to catheters in the upper urinary tract (CUUT) are associated with specific characteristics. Methods: A prospective observational study was carried out from 2012 to 2015 to evaluate infections in patients with CUUT. Results: A total of 209 infections were included (99 with double-J, 81 with nephrostomy, and 29 with internal/external nephroureteral stents). Among nephrostomy tube carriers, the most frequently isolated microorganisms were Pseudomonas and Enterococcus. In those with an internal/external nephroureteral stent, Klebsiella was the most common, and 57.1% were extended-spectrum beta-lactamase-producing Klebsiella. In double-J carriers, Escherichia coli and Enterococcus were the most common microorganisms. Multiple-drug resistance (MDR) microorganisms were isolated in 28.6, 47.1, and 58.3% of patients with double-J, nephrostomy, and internal-external nephroureteral stents. A percutaneous CUUT (p = 0.005) and immunosuppression (p = 0.034) were risk factors for MDR microorganisms. Conclusions: Non-E. coli bacteria are commonly isolated in patients with CUUT. MDR microorganisms are frequent, mainly in percutaneous approach or immunosuppression.

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“…In 1978, the ureteral double-J stent was first described by Finney et al [ 1 , 2 ]. Ureteral double-J stent insertion has been one of the most common urologic procedures; however, indwelling stents are often accompanied by significant morbidity including voiding and storage symptoms, flank pain, hematuria, and infection [ 3 ]. Symptoms of stent discomfort, including bladder irritation symptoms and flank pain or discomfort, are generally treated with oral analgesics, such as narcotics and antiinflammatory medications; however these medications are only moderately effective.…”

Section: Introductionmentioning

confidence: 99%

The beneficial effect of alpha-blockers for ureteral stent-related discomfort: systematic review and network meta-analysis for alfuzosin versus tamsulosin versus placebo

Kwon

Kang³

et al. 2015

BMC Urol

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BackgroundThis study was carried out a network meta-analysis of evidence from randomized controlled trials (RCTs) to evaluate stent-related discomfort in patients with alfuzosin or tamsulosin versus placebo.MethodsRelevant RCTs were identified from electronic databases. The proceedings of appropriate meetings were also searched. Seven articles on the basis of RCTs were included in our meta-analysis. Using pairwise and network meta-analyses, comparisons were made by qualitative and quantitative syntheses. Evaluation was performed with the Ureteric Stent Symptoms Questionnaire to assess the urinary symptom score (USS) and body pain score (BPS).ResultsOne of the seven RCTs was at moderate risk of bias for all quality criteria; two studies had a high risk of bias. In the network meta-analysis, both alfuzosin (mean difference [MD];−4.85, 95 % confidence interval [CI];−8.53–−1.33) and tamsulosin (MD;−8.84, 95 % CI;−13.08–−4.31) showed lower scores compared with placebo; however, the difference in USS for alfuzosin versus tamsulosin was not significant (MD; 3.99, 95 % CI;−1.23–9.04). Alfuzosin (MD;−5.71, 95 % CI;−11.32–−0.52) and tamsulosin (MD;−7.77, 95 % CI;−13.68–−2.14) showed lower scores for BPS compared with placebo; however, the MD between alfuzosin and tamsulosin was not significant (MD; 2.12, 95 % CI;−4.62–8.72). In the rank-probability test, tamsulosin ranked highest for USS and BPS, and alfuzosin was second.ConclusionThe alpha-blockers significantly decreased USS and BPS in comparison with placebo. Tamsulosin might be more effective than alfuzosin.

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Current Status of Ureteral Stent Technologies: Comfort and Antimicrobial Resistance

Cited by 20 publications

References 55 publications

Rate of positive urine culture and double–J catheters colonization on the basis of microorganism DNA analysis

Rate of positive urine culture and double–J catheters colonization on the basis of microorganism DNA analysis

Urinary Infections in Patients with Catheters in the Upper Urinary Tract: Microbiological Study

The beneficial effect of alpha-blockers for ureteral stent-related discomfort: systematic review and network meta-analysis for alfuzosin versus tamsulosin versus placebo

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