Evolution toward early stent removal and reduced antibiotic prophylaxis post-cystectomy

Area of Science:

• Urology
• Surgical Outcomes
• Quality Improvement

Background:

• The optimal duration of ureteral stents following cystectomy remains undefined.
• Current trends explore earlier stent removal or elimination to reduce complications.
• A modified cystectomy pathway was implemented to shorten stent and antibiotic duration.

Purpose of the Study:

• To evaluate the impact of early ureteral stent removal on urinary tract infection (UTI) and urine leak rates.
• To assess the safety and efficacy of a shortened postoperative pathway after cystectomy.

Main Methods:

• Retrospective review of 228 cystectomy patients (2016-2022) with ileal conduit diversion.
• Patients stratified into early (postoperative day ≤5) vs. late (>5) stent removal groups.
• Primary outcomes: 30-day UTI and urine leak rates; secondary outcomes: readmission and hydronephrosis.

Main Results:

• Early stent removal (mean POD 4) resulted in significantly shorter antibiotic exposure (8.2 vs. 21.9 days).
• No significant differences observed in postoperative UTI (9.3% vs. 10.8%), urine leak (2.3% vs. 2.2%), or readmission rates between groups.
• Postoperative imaging showed no difference in hydronephrosis rates.

Conclusions:

• Iterative reductions in ureteral stent duration are feasible and safe.
• Shortened stent duration effectively reduces antibiotic exposure post-cystectomy without adverse effects.
• This quality improvement initiative optimizes patient care pathways after cystectomy.