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Tulone G, Costanzo A, Pavan N, Giaimo R, Claps F, Fasciana TMA, Giammanco A, Bartoletti R, Simonato A. Analysis of Bacterial Stent Colonization: The Role of Urine and Device Microbiological Cultures. Antibiotics (Basel) 2023; 12:1512. [PMID: 37887213 PMCID: PMC10604538 DOI: 10.3390/antibiotics12101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
In this study, we explored the incidence of double J (JJ) contamination of patients who underwent an endourological procedure for urinary stones and ureteral stenosis. We developed a prospective study between January 2019 and December 2021. Ninety-seven patients, 54 male and 43 female, were enrolled. Urine culture was taken during four steps: before stent insertion, a sample from selective renal pelvis catheterization, a sample two days after the JJ insertion and finally, after the stent removal procedure. At the time of the stent removal, 1 cm of proximal and distal ends were cut off and placed in the culture for bacterial evaluation. Cohen's kappa coefficient value (k) and concordance rates of microbiological culture results were evaluated. The study group comprised 56% of male patients. Proximal and distal stent cultures were positive in 81 and 78 patients. The concordance rate of microbiological cultures between proximal and distal double J stent is 88% (k 0.6). The most common pathogens isolated from urine and stent cultures were Enterococcus spp. in 52 cases and Klebsiella spp. in 27 cases.
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Affiliation(s)
- Gabriele Tulone
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
| | - Angela Costanzo
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
| | - Nicola Pavan
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
| | - Rosa Giaimo
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Teresa Maria Assunta Fasciana
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence “G. D’Allesandro”, University of Palermo, 90127 Palermo, Italy; (T.M.A.F.); (A.G.)
| | - Anna Giammanco
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence “G. D’Allesandro”, University of Palermo, 90127 Palermo, Italy; (T.M.A.F.); (A.G.)
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
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Abedi G, Patel RM, Lin C, Clayman RV. Quarter Century Management of Chronic Ureteropelvic Junction Obstruction in a Solitary Kidney with a Ureteral Stent. J Endourol Case Rep 2018; 4:42-44. [PMID: 29662959 PMCID: PMC5899280 DOI: 10.1089/cren.2017.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The ureteral stent provides a conduit for urinary drainage from the kidney to the bladder and is integral to contemporary urologic practice. A ureteral stent is often utilized in acute conditions to prevent or overcome obstruction; however, in nonsurgical patients, because of disease or preference, a ureteral stent may be used as a last resort for long-term management of a stricture in lieu of a nephrostomy tube. This case highlights a patient whose chronic ureteral obstruction has been managed with an indwelling ureteral stent for 25 years; remarkably, stent exchanges are currently required only every 2 years. Case Presentation: A 33-year-old man initially presented with a solitary left kidney and a ureteropelvic junction obstruction. The patient's right kidney was nonfunctioning since childhood because of a presumed ureteropelvic junction obstruction with grade IV hydronephrosis. The patient underwent two failed open repairs of the left kidney in the 1980s, resulting in a totally intrarenal, constricted renal pelvis; an endopyelotomy in 1992 also failed and required angioembolizaton of a segmental renal vessel. The patient refused any further surgical procedures and thus has been managed exclusively with a 7/14F × 28 cm endopyelotomy stent (Boston Scientific®) for 25 years; the interval between stent changes was slowly expanded until they are now being done at 2-year intervals. The patient has not developed recurrent urinary tract infections, stent colic, or stent encrustation. Conclusion: Patients who require chronic indwelling ureteral stents are rare. In this situation, with careful monitoring, the interval between stent exchanges was extended to 2 years, thereby precluding a chronic nephrostomy tube.
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Affiliation(s)
- Garen Abedi
- Department of Urology, University of California, Irvine, Irvine, California
| | - Roshan M. Patel
- Department of Urology, University of California, Irvine, Irvine, California
| | - Cyrus Lin
- Department of Urology, University of California, Irvine, Irvine, California
| | - Ralph V. Clayman
- Department of Urology, University of California, Irvine, Irvine, California
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Experience of retaining encrusted ureteral stents: URL by 4.5/6.5F ureteroscope can reduce the possibility of PCNL. Urolithiasis 2017; 46:357-361. [PMID: 28608037 DOI: 10.1007/s00240-017-0990-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/02/2017] [Indexed: 12/18/2022]
Abstract
The purpose of the study was to present our experience of retaining encrusted ureteral stents (EUS) and discuss the effectiveness of 4.5/6.5F ureteroscope (URS) in the procedure. The data of patients with EUS in our center from January 2012 to December 2016 were retrospectively analyzed. The inclusion criterion was ureteral stents that required intervention above the ureteral orifice to retain and was proved to be encrusted. Impacted stents would be removed by ureteroscope lithotripsy (URL) via 8/9.8F or 4.5/6.5F URS. Percutaneous nephrolithotomy (PCNL) then be the further step if URL failed. 46 cases of EUS were treated in 36 patients from January 2012 to December 2016 in our institution. All subjects consisted of 18 males and 18 females; the average age was 49.81 ± 16.40 years (range 5-86). The mean time from stent insertion to encrustation was 9.28 ± 17.15 months (range 1-120). URL was performed in 44 cases (95.7%), including 19 cases (41.3%) by 8/9.8F URS and 25 cases (54.4%) by 4.5/6.5F URS due to the conventional URS's failure to get into ureteral orifice or further part of ureter. Two patients (4.3%) underwent PCNL due to the inseparable circle developed by the intra-renal segment of encrusted stents. None of the patients underwent extracorporeal shock wave lithotripsy (ESWL) and open surgery. All stents were eventually removed without blood transfusion or ureteral injury, except three cases with post-operative fever. All procedures were performed under one-session anesthesia. URL by 4.5/6.5F ureteroscope might increase the success rate of retaining encrusted ureteral stents remarkably, and then reduce the possibility of PCNL effectively.
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Kliś R, Szymkowiak S, Madej A, Blewniewski M, Krześlak A, Forma E, Bryś M, Lipiński M, Różański W. Rate of positive urine culture and double-J catheters colonization on the basis of microorganism DNA analysis. Cent European J Urol 2014; 67:81-5. [PMID: 24982789 PMCID: PMC4074722 DOI: 10.5173/ceju.2014.01.art18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 11/21/2013] [Accepted: 01/24/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction The aim of the trial was to estimate the relationship between colonization of the Double–J catheter, and the microorganisms cultured from urine. Material and methods 60 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. Results Urine 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. Conclusions Double–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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Affiliation(s)
- Rafał Kliś
- 2nd Department of Urology, Medical University of Łódź, Łódź, Poland
| | | | - Adam Madej
- 2nd Department of Urology, Medical University of Łódź, Łódź, Poland
| | | | - Anna Krześlak
- Department of Cytobiochemistry, Medical University of Łódź, Łódź, Poland
| | - Ewa Forma
- Department of Cytobiochemistry, Medical University of Łódź, Łódź, Poland
| | - Magdalena Bryś
- Department of Cytobiochemistry, Medical University of Łódź, Łódź, Poland
| | - Marek Lipiński
- 2nd Department of Urology, Medical University of Łódź, Łódź, Poland
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Kelkar V, Patil D. Management of forgotten double J stent and severe multiple large encrusted stones in the bladder and renal pelvis. Cent European J Urol 2012; 65:238-41. [PMID: 24578973 PMCID: PMC3921802 DOI: 10.5173/ceju.2012.04.art15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/09/2012] [Accepted: 11/05/2012] [Indexed: 11/22/2022] Open
Abstract
A female patient from a remote village and poor socioeconomic background presented to our clinic with abdominal pain at the right flank. She had a history of endoscopic double J stent placement four years prior. However, the details were not available, as neither the patient nor her relatives were aware of the history. An ultrasonography was performed and revealed moderate hydronephrosis of the right kidney with two calculi measuring 2.9 cm at the pyeloureteral junction (PUJ), a 2.6 cm calculus in the renal pelvis, and a 4 cm vesicle calculus. An intravenous urography revealed delayed excretion of contrast medium in the right kidney. A cystoscopy was then performed and the lower end of the forgotten double J stent was cut along with the encrusted stone in bladder [1, 2]. Removal of the large encrusted bladder stone was aided by lithotripsy. This was followed by the removal of the two PUJ calculi and the remaining portion of the encrusted double J stent, which was extracted with relative ease via a right-sided open pyelolithotomy [3]. The post-operative course was uneventful and her kidney function test was absolutely normal following the procedures. The patient was found to be stone-free and was discharged home. In light of this situation we have deemed it necessary to maintain contact and ensure regular follow-up visits for patients with double J stent placements in order to avoid such dangerous complications in the future. By following this custom, we aim to reduce the patient morbidity and avoid any unnecessary inconvenience.
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Affiliation(s)
- Vidhyadhar Kelkar
- Department of Surgery, Dr. S.C. Government Medical College, Nanded (MS), India
| | - Deepak Patil
- Department of Surgery, Dr. S.C. Government Medical College, Nanded (MS), India
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Treatment of forgotten ureteral stents: how much does it really cost? A cost-effectiveness study in 27 patients. ACTA ACUST UNITED AC 2011; 40:317-25. [PMID: 21833788 DOI: 10.1007/s00240-011-0409-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 07/25/2011] [Indexed: 10/17/2022]
Abstract
Aim of study was to present costs of forgotten ureteral stents extraction so as to distract attentions of the urologists on this issue. Medical files of 27 accessible patients who referred to our clinics between 2001 and 2010 because of forgotten ureteral stent were retrospectively analyzed. The indwelling time of double-j stents (DJS) was calculated from the time of its insertion. Costs related to radiological investigations, all invasive, and noninvasive interventions, duration of hospital stay, and medical treatments used were calculated. These estimations were based on 2010 prices determined by Turkey Ministry of Health. Mean age of the patients was 31.2 (8-86 years) years. Mean indwelling time of ureteral DJSs was 36.7 months (14-84 months). Seventy-one [extracorporeal shock wave lithotripsy (ESWL), n = 26; invasive/noninvasive interventions, n = 32] procedures were applied for 27 patients. In six patients without incrustation, after a single session of ESWL DJSs could be removed cystoscopically. A various combination of a multimodal therapy was used for other 21 patients. Total financial burden of 27 patients was US $ 34,300. Cost of treatment was estimated to be 6.9-fold (1.8- to 21-fold) higher than an average timely stent extraction. Financial burden of the treatments increased in parallel with the duration of the stent retention (p = 0.001). Management of forgotten DJS is time consuming, difficult, complicated, risky, and costly. Therefore; financial burden, increased labour loss, and impaired quality of life brought by the application of these modalities must not be forgotten.
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Klis R, Korczak-Kozakiewicz E, Denys A, Sosnowski M, Rozanski W. Relationship Between Urinary Tract Infection and Self-Retaining Double-J Catheter Colonization. J Endourol 2009; 23:1015-9. [DOI: 10.1089/end.2008.0518] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rafal Klis
- 2nd Department of Urology, Medical University of Lodz, Lodz, Poland
| | | | - Andrzej Denys
- Department of Microbiology, Medical University of Lodz, Lodz, Poland
| | - Marek Sosnowski
- 1st Department of Urology, Medical University of Lodz, Lodz, Poland
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Wall I, Baradarian R, Tangorra M, Badalov N, Iswara K, Li J, Tenner S. Spontaneous perforation of the duodenum by a migrated ureteral stent. Gastrointest Endosc 2008; 68:1236-8. [PMID: 18547569 DOI: 10.1016/j.gie.2008.02.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 02/27/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Ian Wall
- Department of Internal Medicine, Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York 11219, USA
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Aron M, Ansari MS, Singh I, Gautam G, Kolla SB, Seth A, Gupta NP. Forgotten ureteral stents causing renal failure: multimodal endourologic treatment. J Endourol 2006; 20:423-8. [PMID: 16808657 DOI: 10.1089/end.2006.20.423] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report our experience in managing nine patients with forgotten ureteral stents that resulted in chronic renal failure (CRF). PATIENTS AND METHODS We reviewed our stent records from January 1994 to January 2004 to analyze cases of forgotten indwelling ureteral stents in solitary kidneys that had led to CRF (serum creatinine 4-14 mg/dL). These patients had normal renal function prior to the interventions at which stents were placed. They were subjected to multimodal endourologic management, including cystolithotripsy and ureteroscopic and percutaneous lithotripsy, to make them stent and stone free in a single operative session. RESULTS The median dwell time of the retained stents was 39 months. Three patients were not aware of the stent, while six chose to ignore it. All patients underwent a temporizing percutaneous nephrostomy with an 8F pigtail catheter and were operated on 2 to 4 weeks later. All nine patients were rendered stone and stent free; however, one patient succumbed to septic complications 3 weeks after the operation. At last follow-up (6-56 months), two patients are on the transplant waiting list, while six are living with mild to moderate renal failure on conservative treatment. CONCLUSIONS Chronic renal failure caused by encrusted stents in a functionally solitary kidney is a disastrous complication of forgotten stents. Prevention is, of course, ideal, but such cases are still seen despite increasing awareness. Temporizing percutaneous nephrostomy, renal support, and skilled endourologists are the cornerstones of management of such high-risk cases.
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Affiliation(s)
- Monish Aron
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
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Park K, Jeon SS, Park H, Kim HH. Clinical features determining the fate of a long-term, indwelling, forgotten double J stents. ACTA ACUST UNITED AC 2004; 32:416-20. [PMID: 15490143 DOI: 10.1007/s00240-004-0442-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2004] [Accepted: 07/12/2004] [Indexed: 11/26/2022]
Abstract
We review our experiences with forgotten stents and investigate the potential factors determining the degree of encrustation. Our series consists of nine cases of forgotten stent that had remained indwelling for more than 1 year (mean 36.1 months). We describe and compare their various clinical parameters in terms of encrustation. In addition, we briefly summarize our management schemes. All patients showed few stent related irritative symptoms. Six cases showing minimal or no encrustation shared the common feature of urine hypotonicity. Cystoscopic pullout was possible in these cases. The remaining three cases showed moderate to severe encrustation around the stent which required multiple procedures. Pyuria was observed in all cases and two patients had a history of urolithiasis. Finally, all cases were rendered stent and stone free. The fate of forgotten stents was dependent on the amount of encrustation around the stent. In our study, lithogenic history and presence of pyuria were associated with moderate to severe encrustation. Interestingly, patients showing urine hypotonicity tended to have a minimal encrustation on their stents and the stents were easily removed. Therefore, in patients with an impaired renal concentrating ability and a poor medical condition, the duration of indwelling stents might be safely prolonged if the patient has no risk factor for encrustation. As patients with forgotten stents are less likely to complain of stent related symptoms, thorough education of patients is important to prevent stent related complications.
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Affiliation(s)
- Kwanjin Park
- Department of Urology, College of Medicine, Seoul National University, 28 Yon Gon Dong, 110-744 Chongno-Gu, Seoul, Korea
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Abstract
Double J (DJ)stents are a comfortable method for assuring urine passage with little or no burden for the patient. However, the lack of or minimal impairment of physical activity has the disadvantage that an inserted DJ stent can be "forgotten". In cases of encrustation, stent removal can be impossible or a stent can tear off. To remove encrusted stents all modern, minimally invasive endourological techniques are used. In rare cases, surgical procedures are essential. To avoid these difficulties, patients with DJ stents have to be closely checked to recognize the beginning of encrustation as early as possible. The removal of DJ stents should be carried out as early as possible in patients for whom they are required only short-term.
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Affiliation(s)
- H-J Knopf
- Urologische Klinik, Klinikum Dortmund, Akademisches Lehrkrankenhaus der Universität Münster, Germany.
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