Are antibiotics necessary during routine cystoscopic stent removal? (2022)

Original Article

Joel E. Abbott1, Allison Han2, Michelle McDonald1, Charlie Lakin1, Roger L. Sur1

1Department of Urology, University of California, San Diego, San Diego, CA, USA;2University of California San Diego School of Medicine, San Diego, CA, USA

Contributions: (I) Conception and design: JE Abbott, M McDonald, RL Sur; (II) Administrative support: C Lakin, RL Sur; (III) Provision of study materials or patients: JE Abbott, C Lakin, RL Sur; (IV) Collection and assembly of data: JE Abbott, A Han, M McDonald; (V) Data analysis and interpretation: JE Abbott, A Han, M McDonald, RL Sur; (VI) Manuscript writing: All Authors; (VII) Final approval of manuscript: All Authors.

Correspondence to: Joel E. Abbott, DO; Roger L. Sur, MD. Department of Urology, University of California San Diego, 200 West Arbor Drive #8897, San Diego, CA 92103, USA. Email: jeabbott@ucsd.edu; rlsur@mail.ucsd.edu.

Background: The 2008 American Urological Association (AUA) Best Practice Statement on antimicrobial prophylaxis states that prophylaxis is not warranted for subjects with normal risk profile undergoing cystourethroscopy unless manipulation such as ureteral stent removal is performed. To date no studies have specifically assessed the need for antimicrobial prophylaxis during cystoscopic ureteral stent removal. We sought to determine the risk of infectious complications following cystoscopic stent removal with and without antimicrobial prophylaxis.

Methods: A retrospective review identified 70 subjects who underwent cystoscopic ureteral stent removal following kidney stone treatment, under the care of two separate urologists with differing practice patterns. Each cohort consisted of 35 subjects: with and without prophylactic antibiotics. Clinical variables assessed included demographics, type of stone intervention, prior urinary tract infection (UTI) history, immunocompromising comorbidities, antimicrobial class at time of stone intervention, and antimicrobial administration at cystoscopic stent removal. The primary outcome assessed was development of symptomatic UTI within 4 weeks after stent removal.

(Video) JJ Stent (removal of kidney stones)

Results: Overall, 35 patients (50%) received antimicrobial prophylaxis at the time of stent removal and 35 (50%) did not receive antimicrobial prophylaxis, with no demographic or clinical differences between cohorts. Two patients in the antimicrobial cohort (6%) developed a UTI and none of the patients who did not receive antimicrobial prophylaxis developed a UTI (P=0.15).

Conclusions: In our cohort study antimicrobial prophylaxis at the time of cystoscopic stent removal did not appear to provide a significant benefit in UTI prevention. Prospective studies would assist in validating these findings.

Keywords: Kidney calculi; kidney surgery; urinary tract infection (UTI); stents; urologic surgical procedures

Submitted Jul 05, 2016. Accepted for publication Jul 27, 2016.

doi: 10.21037/tau.2016.08.13

Introduction

Healthcare associated infection is a major challenge to modern healthcare and patient safety. Infectious complications following urological procedures are a significant source of patient morbidity and mortality and consume healthcare resources; however widespread overuse of antibiotics has significantly contributed to the growing bacterial resistance. Balancing judicious antibiotics use to avoid iatrogenic microbial resistance against timely use of antibiotics to prevent morbidity of infectious complications continues to challenge health care providers. Reliance on literature to guide decision-making becomes critical for health care providers.

The introduction of the American Urological Association (AUA) Best Practice Statement has provided this necessary guidance to urologists across the variety of urological surgeries (1). Routine revisions to this statement have kept the recommendations contemporary and in keeping with evolving evidence. And yet not all recommendations have literature to support their statements, requiring generalizations to support some guidelines. In particular, the recommendation of antibiotic use during cystoscopic stent removal is based on this type of generalized data from transurethral resection literature findings. However, this recommendation seems to fail the intuitive test as a cystoscopic stent removal carries a much less invasive morbidity than either transurethral resection of prostate or bladder tumor. In this context, we hypothesize that antibiotics at time of cystoscopic stent removal provide minimal benefit. We therefore sought to determine if antibiotics indeed provided benefit in reducing infectious complications for cystoscopic stent removal procedure.

Methods

After Institutional Review Board was obtained (UCSD Human Research Protection Program #160159), we retrospectively reviewed the medical records of all patients presenting to UC San Diego Health Comprehensive Kidney Stone Center clinic from October 2014 to October 2015 seeking to include any subject who underwent cystoscopic ureteral stent removal. A total of 70 subjects under the care of two separate urologists (Roger L. Sur & Charlie Lakin) with differing practice patterns were identified in order to isolate two cohorts of subjects: 35 received (Roger L. Sur subjects) and 35 did not (Charlie Lakin subjects) receive prophylactic antibiotics. Cohort 1 utilized single dose antibiotics after the procedure, while cohort 2 did not utilize antibiotics after the procedure. As per the current AUA best practice policy statement the following antibiotics were utilized: fluoroquinolones, cephalosporins, aminoglycosides, or trimethoprim-sulfamethoxazole (TMP-SMX) (1).

(Video) Removal of Double J stent by Cystoscopy

Inception cohort

All subjects undergoing upper tract stone treatment, including percutaneous nephrolithotomy (PNL), ureteroscopy/lithotripsy (URS), or shock wave lithotripsy, had ureteral stents placed intraoperatively. All patients received <24 hours of prophylactic antibiotics at the time of their initial surgical procedure in accordance with our institution’s protocol of weight-based dose of gentamycin and ampicillin. Vancomycin was used to replace ampicillin in patients with allergy concern and ceftriaxone was used to replace gentamycin for patients with impaired renal function glomerular filtration rate (GFR) <60. Patients presented 1–2 weeks post-operatively to have their stents removed in the clinic. Exclusion criteria included positive preoperative urine cultures, presence of indwelling external urinary drain tubes (Foley catheters, nephrostomy tubes), performance of clean intermittent catheterization, stent duration >2 weeks, and concurrent antimicrobial administration at time of cystoscopic stent removal.

Primary outcome

The primary outcome assessed was development of urinary tract infection (UTI) within 4 weeks after stent removal. UTI was defined in accordance with the standardized American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) definition of postoperative UTI (2). ACS NSQIP standardized UTI definition is listed in Figure 1.

Are antibiotics necessary during routine cystoscopic stent removal? (1)

Figure 1 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) criteria to define post-operative UTI (2).

Descriptive statistics

Demographic variables were reported with mean, median and appropriate measures of variance for continuous variables and proportions for categorical variables. Other clinical variables reported included type of stone intervention, UTI history, immunocompromising comorbidities, antimicrobial class at time of stone intervention, and antimicrobial administration at cystoscopic stent removal.

Inferential statistics

Student’s t-test was used to compare continuous variables as they were parametric in distribution. Pearson’s chi-square/Fisher’s exact test was used for categorical data analysis and reported with odds ratio (OR) and 95% confidence intervals (CI). All P values were two-tailed and statistical significance was set at P<0.05. Analyses were performed in SAS 9.3 (SAS Institute, Cary, NC, USA).

Results

A total of 122 medical charts were reviewed to obtain the 70 subjects meeting the inclusion criteria for the study: 35 (Roger L. Sur) subjects received prophylactic antibiotics at time of cystoscopic stent removal and 35 (Charlie Lakin) subjects did not received antibiotics at time of cystoscopic stent removal. No significant differences in either demographic or clinical variables were identified between these cohorts (Table 1), though cohort 1 had two subjects with human immunodeficiency virus (HIV) and one subject with history of chemotherapy (P=0.49 and P=1.0, respectively). Mean indwelling stent duration between the two groups was 9.09 (±3.23) days in cohort 1 and 9.94 (±2.99) days in cohort 2. The antimicrobial-receiving cohort in this retrospective study received ciprofloxacin preferentially (n=31, 89%), gentamicin (n=2, 6%), cefalexin (n=1, 3%), and TMP-SMX (n=1, 3%). Antibiotic selection was based on physician preference influenced on patient allergy profile but in keeping with AUA Best Practice Statement.

(Video) Why does it hurt when I urinate with a ureteral stent?

Are antibiotics necessary during routine cystoscopic stent removal? (2)

Table 1 Demographic and clinical variables of both cohorts

Full table

With regard to the primary outcome, there was no statistical difference in UTI rates between the two groups (P=0.151). In the antimicrobial cohort, two patients (6%) developed a UTI. In the cohort not receiving antimicrobial prophylaxis, none of the patients developed UTIs. Among the patients diagnosed with UTI, one UTI was secondary to >100k colony-forming units (CFU) Staphylococcus epidermidis, while the other UTI was secondary to >100k CFU Strepococci viridans. Both patients were treated to resolution with culture-specific oral antibiotics with immediate resolution of symptoms. Of note none of these subjects who suffered UTI’s had history of HIV or chemotherapy.

The UTI secondary to Strepococci viridans occurred in a male who was HIV positive. The UTI secondary to Staphylococcus epidermdis occurred in a female with no comorbidities.

Discussion

The purpose of antimicrobial prophylaxis in surgical procedures is not to sterilize the tissues but to reduce the colonization of microorganisms introduced at the time of operation to a level that the patient’s immune system is able to overcome (3). Before an agent can be considered for use as a prophylactic antibiotic, there must be evidence that it reduces postoperative infection. Agents used must be safe, ideally economical and effective against organisms likely to be encountered in the surgical procedure. Postoperative UTIs are a major concern for morbidity in patients after urological procedures, and this concern is used to justify the use of prophylaxis with stent removal (1,4).

However, we failed to find a benefit to antimicrobial prophylaxis within this cohort study. Perhaps the non-invasive nature to this procedure as well as paucity of risk factors explains the lack of significant differences in infectious complications. The difference between cystoscopy and cystoscopic stent removal is that a foreign body is grasped and removed from the urinary tract. Since this maneuver should reestablish the anti-refluxing mechanism of the ureteral-vesicle junction (allowing continued passive renal drainage without ureteral reflux), bacteria within the bladder should not be transmitted retrograde, and colonized urine in the upper tract is permitted continuous drainage in an antegrade fashion. Obstruction is not routinely observed after simple stent removal following stone treatment (5). Furthermore, the ureteral stent functions as a surgical drain to the kidney.

(Video) What is a Ureteral Stent? How is a stent placed & removed?-Dr. Manohar T

The basis of the current antimicrobial prophylaxis during cystoscopic stent removal derives from AUA panel conclusion that similarities of these other cystoscopic procedures in terms of invasiveness and potential tissue trauma suggest that the data regarding transurethral resection of the prostate and bladder tumor reasonably can be extrapolated to other cystoscopic procedures with manipulation (1). The presumption that prior transurethral resection literature is translatable to this much less invasive procedure seems clinically irrational. Both are “invasive” but the similarities end there—as cystoscopic stent removal is no more invasive than Foley catheter removal. There is no tissue removal, no tissue trauma and really no “invasiveness” to stent removal from a clinical perspective. Given the lack of specific data to justify antibiotic use, juxtaposed with known increasing risks of antibiotic resistance, literature supporting prophylaxis should be ideally expected to enhance panels create recommendations (6).

However there may be specific risk factors that warrant prophylaxis at the time of stent removal—just as Foley catheter removal with risk factors merits antibiotics. Patients at risk for infectious complications following urologic intervention have previously been defined as patients with recent urosepsis, anomalies of the urinary tract, urinary obstruction, incomplete bladder emptying, chronic externalized urinary tract drains/catheters, and history of recurrent UTI’s (1,4,7). Until the literature provides better delineation of the at-risk populations the benefit to risk ratio tilts towards prophylaxis for this cohort.

The purpose of this retrospective analysis was to examine the efficacy and therefore necessity of providing antimicrobial prophylaxis at the time of cystoscopic stent removal with the primary end point of UTI incidence. By excluding patients who demonstrated positive preoperative urine cultures, had external drain tubes or catheterizations, concurrent antimicrobial administration, and stents for longer than 2 weeks, we attempted to eliminate possible confounding factors and assess uncomplicated patients with minimal baseline risk of UTI. We examined other variables that may generally increase risk for infection including immune-compromised state (cancer, diabetes mellitus, HIV), obesity, old age, smoking, though we did not exclude patients based upon these factors.

Our study has limitations, including its retrospective design and small sample size. Additionally, the small number of patients who developed UTIs may under-power the study, though the current 6% difference in this retrospective study would require prospective sample size of approximately 2,000 subjects. This retrospective study therefore provides the basis for future prospective trials to validate our findings. We acknowledge other limitations. The antibiotic regimen was not standardized and represented physician preference. It is conceivable that the prescribing urologist in cohort 1 treated higher risk patients with broader coverage antimicrobial.

Conclusions

Antibiotic prophylaxis at the time of cystoscopic stent removal following endoscopic stone treatment for simple stent removal did not decrease the risk of UTI in uncomplicated patients in this cohort study. This is a significant finding to explore, as unnecessary antimicrobial usage increases healthcare costs, places patients at risk for antimicrobial related adverse events, and potentially introduces resistant organisms to the community. Further prospective investigations should be considered to validate these findings.

Acknowledgements

None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: This study was done in accordance with UCSD IRB protocol #160159. However, the study was considered exempt from IRB review as per federal regulations [45 CFR 46.101(b)]. The study met criteria for exempt category 4: research involving collection or study of existing data, documents, records, or specimens, the information is recorded by the researcher in such a manner that subjects cannot be identified, directly or through identifiers linked to the subjects.

(Video) RIRS and DJ Stent Removal Patient Feedback

References

  1. Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol 2008;179:1379-90. [Crossref] [PubMed]
  2. National Surgical Quality Improvement Program: Non-cardiac terms & definitions, revisions to definitions 9-1-95. In: Managerial I Site Operations Manual St Louis, MO. St. Louis, MO: Continuing Education Center, 1995.
  3. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97-132; quiz 133-4; discussion 96. [Crossref] [PubMed]
  4. Matsumoto T, Kiyota H, Matsukawa M, et al. Japanese guidelines for prevention of perioperative infections in urological field. Int J Urol 2007;14:890-909. [Crossref] [PubMed]
  5. Manger JP, Mendoza PJ, Babayan RK, et al. Use of renal ultrasound to detect hydronephrosis after ureteroscopy. J Endourol 2009;23:1399-402. [Crossref] [PubMed]
  6. Patel N, Shi W, Liss M, et al. Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol 2015;29:531-6. [Crossref] [PubMed]
  7. Grabe M, Bjerklund-Johansen TE, Botto H, et al. Guidelines on Urological Infections 2013. Available online: http://uroweb.org/guideline/urological-infections/

Cite this article as: Abbott JE, Han A, McDonald M, Lakin C, Sur RL. Are antibiotics necessary during routine cystoscopic stent removal? Transl Androl Urol 2016;5(5):784-788. doi: 10.21037/tau.2016.08.13

FAQs

How can I prevent UTI after stent removal? ›

After the stent removal, you may need to urinate often. You may have some burning during and after urination for a day or two. It may help to drink lots of fluids (unless your doctor tells you not to). This also helps prevent a urinary tract infection.

How long is recovery after ureteral stent removal? ›

Your physical activity is to be restricted, especially during the first weeks of recovery. During this time use the following guidelines: NO lifting heavy objects (anything greater than 10 lbs) for 4 weeks. NO driving a car and limit long car rides for 2 weeks.

Is it common to get UTI after stent removal? ›

Time from stent removal to UTI occurrence. Most of the UTIs during the first 6 months post renal transplantation are stent related (occurs while the stent in place and up to two weeks post stent removal). After the stent removal, UTIs clearly become sporadic and less frequent.

How long will my kidney hurt after stent removal? ›

What can I expect after removal of the stent? You may have bloody urine, possibly with some small clots. You may also have “achy” pain due to ureteral spasms. This generally only last a few hours, but should resolve over the next 2-3 days.

Do you need antibiotics after ureteral stent placement? ›

A thin tube called a stent may be placed in the ureter for several weeks to help with healing. Antibiotics may be prescribed to prevent a urinary tract infection (UTI) from the stent, but this study found they are not necessary for most children.

Is it normal to have kidney pain after ureteral stent removal? ›

It is normal to have some discomfort for several days after stent removal. This should gradually resolve over 3 to 5 days. The pain should not be as intense as was the original kidney stone.

How do you feel after stent removal? ›

After the stent removal, you may need to urinate often. You may have some burning during and after urination for a day or two. It may help to drink lots of fluids (unless your doctor tells you not to). This also helps prevent a urinary tract infection.

How much pain is there after ureteral stent removal? ›

The majority of patients reported moderate-to-severe levels of pain with stent removal, with an overall mean pain of 4.8 on a scale of 1 to 10.

Is anesthesia given during ureteral stent removal? ›

Conclusions: Ureteroscopic removal of a migrated stent using local anesthesia is effective, safe and tolerable in select patients. Preventing the complications and costs associated with general or spinal anesthesia makes this option appealing to patients and it should be offered when possible.

Is it painful to have a ureteral stent removed? ›

Results: Of the 104 individuals in the final cohort, 64% had symptoms after stent removal (pain, hematuria, frequency, urgency, or fever), and among those with symptoms, 60% experienced pain/discomfort.

Can a stent cause a bladder infection? ›

Having a stent, along with your original kidney problem, can make it more likely that you will develop a urinary tract infection. Symptoms of an infection include feeling cold and shivery, with a raised temperature above 37.5°C, increased pain or discomfort, a burning sensation when passing urine and feeling unwell.

Can I take a bath after stent removal? ›

The string facilitates stent removal. If present, you may shower immediately after discharge but please no baths until the stent is removed. If the stent is placed without a string Page 5 you may take a bath after being discharged.

How long does stent removal take? ›

In expert hands the process of DJ stent removal usually takes 10 to 20 seconds. The process of shifting to the theater and shifting back to the private room may require 15 to 20 minutes.

Is it painful to remove stent? ›

Take hold of the string and with a firm, steady motion, pull the stent until it is out. Remember that it is approximately 25-30 cm long. This will feel uncomfortable but it should not be painful.

Is cystoscopy with stent removal painful? ›

The cystoscopic removal of ureteral stents causes discomfort and pain, especially in young male patients.

Can a stent damage your ureter? ›

On the other hand, polyurethane stents are rigid, easy manageable during placement but cause patient discomfort and may cause ureteral erosion. Stone encrustation is another problem in long term use.

Can a kidney stent get infected? ›

Stent-associated infections

One of the most common complications associated with indwelling ureteral stents is bacterial adhesion to the stent surface followed by biofilm formation, which potentially leads to infection and, in some patients, urosepsis.

How long can a stent stay in your kidney? ›

Up to 3 months, and depending on if the growth will be removed, a stent can be left in place for years. However, stents must be changed on a regular basis of every 3-4 months.

How long does hydronephrosis last after stent removal? ›

Hydronephrosis in patients with postoperative edema was seen to be resolved in the subsequent imaging modalities obtained on ultrasonograms or CT within 6 months. Stone-free status was achieved in 415 (91.2%) patients following the procedure.

How does urologist remove stent? ›

To remove the stent during a procedure, your provider: Inserts a cystoscope through the urethra and into the bladder. Uses tiny clamps attached to the cystoscope to grab onto the stent. Gently removes the stent.

Why are kidney stents so painful? ›

A3: There are two "pigtail" curls on the stent, one in the kidney and one in the bladder. The curl resting in the bladder will irritate the lining of the bladder and trigger spasms. Bladder spasms give the patient the severe and immediate urge to urinate.

Are you awake for kidney stent removal? ›

Stent Removal

Most patients stay awake when a stent is removed, but you may have a numbing gel applied to your urethra (your urinary tract opening) before the procedure. If your stent has a string attached, your doctor gently pulls on it to remove the stent.

What are the signs of kidney stent failure? ›

They include irritative voiding symptoms including frequency, urgency, dysuria, incomplete emptying; flank and suprapubic pain; incontinence, and hematuria.

How long does it take to recover from kidney stent surgery? ›

Most patients are able to perform normal, daily activities within 5-7 days after ureteroscopy. However, many patients describe more fatigue and discomfort with a ureteral stent in the bladder. This may limit the amount of activities that you can perform.

Is it normal to bleed after ureteral stent removal? ›

You may also notice some blood in your urine. This is normal, although you should notify your doctor if it doesn't go away or gets worse after several days of recovery. Some patients may instantly sleep better after a stent removal, while others may still be kept awake by discomfort or pain.

Can I take pain meds before stent removal? ›

A single dose of a nonsteroidal anti-inflammatory drug (NSAID) before ureteric stent removal can prevent severe pain afterwards, a study found.

Is it normal to pee blood clots with a stent? ›

Post Procedure

It is common and even expected to have some discomfort while urinating. Patients may have no blood in the urine, mild blood, or even what appears to be a significant amount of blood or small clots. The blood usually disappears in a few days.

Can you get sepsis from a stent? ›

Conclusions. Patients who undergo ureteroscopy after ureteric stent insertion have a higher risk of postoperative sepsis. Prolonged stent dwelling time, sepsis as an indication for stent insertion, and female gender are independent risk factors.

What are the side effects of a stent in the kidney? ›

While the stent is in place, you may have to urinate more often, feel a sudden need to urinate, or feel like you can't completely empty your bladder. You may feel some pain when you urinate or do strenuous activity. You also may notice a small amount of blood in your urine after strenuous activities.

Can you pass a kidney stone with a stent in? ›

Conclusions: A small, but clinically significant percentage of ureteral stones pass spontaneously with a ureteral stent in place. Small stone size is associated with an increased likelihood of spontaneous passage in patients with indwelling stents.

How long do you bleed after ureteral stent? ›

For several hours after the procedure you may have a burning feeling when you urinate. This feeling should go away within a day. Drinking a lot of water can help. You may have some blood in your urine for 2 or 3 days.

What happens if you leave a stent in too long? ›

If left in place for too long, a stent can become encrusted with a “crystal” (stone-like) coating on its surface. This does not normally cause problems although it may worsen some urinary side-effects (especially pain & bleeding).

How does doctor remove ureteral stent? ›

Or your doctor will remove it with the string in the doctor's office or hospital. If there is no string, you will need to have a procedure to remove the stent. It's done using a thin, lighted tube called a cystoscope, or scope. The doctor inserts the scope into your urethra and on into the bladder.

What type of sedation is used for cystoscopy? ›

For a rigid cystoscopy: you're given an injection of general anaesthetic (which makes you fall asleep) into your hand, or a spinal anaesthetic (which numbs the lower half of your body) into your lower back.

What to avoid after having a stent? ›

In most cases, you'll be advised to avoid heavy lifting and strenuous activities for about a week, or until the wound has healed.

Can I take a bath after stent removal? ›

The string facilitates stent removal. If present, you may shower immediately after discharge but please no baths until the stent is removed. If the stent is placed without a string Page 5 you may take a bath after being discharged.

Can ureteral stents cause infection? ›

Ureteral stents may lead to bacterial colonization similarly to all inserted synthetic medical devices. As the use of ureteral stents increased, the incidence of complicated urinary tract infection, which is one of the complications of ureteral stent, has also increased.

How long does it take to recover from kidney stent surgery? ›

Most patients are able to perform normal, daily activities within 5-7 days after ureteroscopy. However, many patients describe more fatigue and discomfort with a ureteral stent in the bladder. This may limit the amount of activities that you can perform.

Do you need medication after a stent? ›

Most people who have undergone angioplasty with or without stent placement will need to take aspirin indefinitely. Those who have had stent placement will need a blood-thinning medication, such as clopidogrel, for six months to a year.

How long do you need to be on blood thinners after a stent? ›

It has been common practice for patients who have had a stent placed to clear a blocked artery to take an anti-clotting drug (such as Plavix, Effient, or Brilinta) plus aspirin for 12 months after the procedure. Taking these two medications, called dual anti-platelet therapy, reduces the risk of forming blood clots.

Can I drink coffee after a stent? ›

Coffee is not recommended right after any form of cardiac surgery, including heart valve surgery.”

How painful is ureteral stent removal? ›

The majority of patients reported moderate-to-severe levels of pain with stent removal, with an overall mean pain of 4.8 on a scale of 1 to 10.

Is anesthesia given during ureteral stent removal? ›

Conclusions: Ureteroscopic removal of a migrated stent using local anesthesia is effective, safe and tolerable in select patients. Preventing the complications and costs associated with general or spinal anesthesia makes this option appealing to patients and it should be offered when possible.

How long does stent removal take? ›

In expert hands the process of DJ stent removal usually takes 10 to 20 seconds. The process of shifting to the theater and shifting back to the private room may require 15 to 20 minutes.

How do you know if your stent is infected? ›

These cases of stent infection share similar clinical features: fever usually accompanied with an episode of chest pain. Diagnosis of stent infection can be challenging. Clinical suspicion should be high in patients with previous intervention, unexplained fever, positive blood cultures, and chest pain.

Can you get sepsis from a stent? ›

Conclusions. Patients who undergo ureteroscopy after ureteric stent insertion have a higher risk of postoperative sepsis. Prolonged stent dwelling time, sepsis as an indication for stent insertion, and female gender are independent risk factors.

Can a stent damage your ureter? ›

On the other hand, polyurethane stents are rigid, easy manageable during placement but cause patient discomfort and may cause ureteral erosion. Stone encrustation is another problem in long term use.

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