Presentation Authors: Aaron Bradshaw*, Dimitri Papagiannopoulos, Seth K. Bechis, Mark Pe, Kaitlan Cobb, Roger L. Sur, San Diego, CA
Introduction: Current AUA Best Practice Statement recommends antibiotic prophylaxis for cystoscopy with manipulation, including stent removal, although no level 1b trials explicitly address prophylaxis for stent removal. We sought to prospectively determine the efficacy of prophylactic antibiotics to prevent infectious complications after cystoscopic stent removal.
Methods: Following IRB approval, subjects undergoing removal of ureteral stent placed during stone surgery were recruited at UC San Diego and Genesis Healthcare from July 2016 to October 2018. Co-variates included age, BMI, comorbidities, surgery type, stone composition, UTI history, bladder urine culture (UCx) at stone surgery, bladder UCx and post-void residual at time of stent removal. Subjects were recruited at time of stent removal and randomized to treatment (single dose 500mg oral Ciprofloxacin) or control group (nothing). Subjects with indwelling stents longer than 3 weeks were excluded. Telephone contact with subject was performed 14 days after stent removal to assess for UTI symptoms, antibiotic prescriptions, or ED visits. Primary outcome was UTI within 2 weeks of stent removal-- defined by irritative void symptoms, fever or abdominal pain associated with clean catch culture >100k colonies/mL.
Results: To date, 65 subjects have been enrolled with 46 meeting final inclusion criteria for analysis (26 treatment, 20 control). No differences were seen with clinical and demographic variables (all p>0.053). Positive Ucx rate prior to stone surgery (16.7% vs. 11.8%, p=0.819) and at time of stent removal (16.0% vs. 11.1%, p=0.648) was not significantly different in treatment vs. control groups, respectively. Primary outcome: No subjects in either cohort developed symptomatic culture-diagnosed UTI within two weeks of stent removal. Of those subjects with documented phone follow up (Treatment n=22, Control n=19), no subjects in either group reported fever, seeing a physician or an emergency department for urinary complaints, receiving additional antibiotics or being admitted for infection.
Conclusions: Initial data suggests antibiotic prophylaxis for cystoscopic removal of ureteral stents does not reduce infectious complication rate. Completion of the trial will help determine if the necessity of antibiotics during routine cystoscopic stent removal warrants AUA Best Practice Statement re-evaluation.