Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis

Area of Science:

• Urology
• Infectious Disease
• Surgical Outcomes

Background:

• Ureteroscopy is a common procedure for kidney stone extraction.
• Ureteral stent placement is often necessary but may be associated with complications.
• Post-operative sepsis is a serious concern following ureteroscopy.

Purpose of the Study:

• To investigate the relationship between ureteral stent dwelling time and the incidence of sepsis after ureteroscopy.
• To identify independent risk factors for sepsis in patients undergoing ureteroscopy, particularly those with prior stent insertion.

Main Methods:

• A prospectively collected database of 1,256 patients undergoing ureteroscopy for stone extraction (2010-2016) was analyzed.
• Logistic regression models were used to identify predictors of post-ureteroscopy sepsis.
• Specific analysis focused on 601 patients with pre-operative ureteral stent placement.

Main Results:

• Sepsis occurred in 4.7% of patients with prior stent insertion versus 1.2% without.
• Sepsis rates increased with prolonged stent dwelling time: 1% (1 month), 4.9% (2 months), 5.5% (3 months), and 9.2% (>3 months).
• Independent risk factors for sepsis in stented patients included longer stent dwelling time, stent insertion due to sepsis, and female gender.

Conclusions:

• Ureteroscopy following ureteral stent insertion is associated with an elevated risk of postoperative sepsis.
• Prolonged stent dwelling time, sepsis as an indication for stenting, and female gender are significant independent risk factors.
• Stent placement should be carefully considered, and ureteroscopy ideally performed within one month of stent insertion.