Management of infected indwelling ureteral stents An international survey of urologists

There are no clinical guidelines for the manipulation of chronic indwelling ureteral stents. The goal of this study was to survey, through a simulated case, how urologists initially manage a patient with a chronic ureteral stent presenting with urosepsis.

An online questionnaire was shared from July 1 to August 31, 2021, through social media (Twitter) and email lists. The scenario described a 50-year-old female, known for a chronic indwelling ureteral stent, presenting to the emergency department with fever, tachycardia, and flank pain. In the scenario, the stent was in adequate position and the last exchange had been performed one month prior. Respondents could choose between treating with antibiotics and keeping the same exchange schedule, urgent stent exchange, or an alternative management that they defined. P<0.05 was considered significant.

A total of 396 participants completed the survey. Responses from 48 countries were collected, with 135 (34.1%) respondents from Canada. Half (50%) of respondents had more than 10 years of experience. Most (79.3%) respondents opted for initial empiric antibiotic therapy, while 16.2% opted for urgent stent exchange. A total of 19 (4.9%) medical specialists completed the survey. Non-urologists opted more frequently than urologists (42.1% vs. 16.2%) for urgent stent exchange (p=0.0111).

This questionnaire allowed us to explore the various managements proposed by urologists in a patient with urosepsis and chronic indwelling ureteral stent. Most urologists opted for initial medical management. Further clinical studies could help determine the necessity for ureteral stent manipulation in urosepsis, and, if present, its ideal timing.