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A randomized controlled trial comparing antimicrobial (silver sulfadiazine)-coated ureteral stents with non-coated
Ahmed R El-Nahas1, Mohammed Lachine1, Essam Elsawy1
1a Urology Department, Urology and Nephrology Center , Mansoura University , Mansoura , Egypt.
Objective:
The aim of this study was to compare the efficacy of antimicrobial [silver sulfadiazine (SSD)]-coated ureteral stents with non-coated stents in the prevention of stent-related bacteriuria.
Materials And Methods:
A randomized controlled trial was conducted between September 2014 and September 2016 after approval from the local ethics committee. Inclusion criteria were adults who underwent unilateral double-J ureteral stent placement after ureteroscopic lithotripsy. All patients underwent placement of the same stent type (Carbothan® with hydrophilic surface) and dimensions (6 F, 26 cm). In the test group, stents were coated with SSD. Patients who used antibiotics during the stenting period or underwent stent removal elsewhere were excluded from the study. Urine and stent cultures were obtained on the day of stent removal. All patients answered the Ureteral Stent Symptom Questionnaire (USSQ).
Results:
The study included 126 patients. The mean ± SD stent duration was 3.1 ± 1.2 weeks. There were no significant differences between groups in the incidence of bacteriuria and USSQ scores. However, two stents (3.2%) in the SSD group had significant bacterial growth, compared to eight stents (12.5%) in the control group (p = 0.054). The incidence of newly diagnosed bacteriuria was higher in the control group (11%) than the antimicrobial group (6.5%), but the difference was not significant (p = 0.372).
Conclusions:
This study could not justify the use of antimicrobial (SSD)-coated stents for short stenting periods. The trend towards decreasing stent colonization in the antimicrobial group was not translated to a significantly lower incidence of stent-related bacteriuria or improvement in patients' quality of life.