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Early stent removal following radical cystectomy does not increase risk of UTI, urine leak

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"At our institution, we used a [quality improvement] protocol to first decrease overall antibiotic duration from the more standard 30 days, and then we further decreased it along with ureteral stent decrease,” says Jessica Wenzel, MD, MPH.

Patients who had an early ureteral stent removal following radical cystectomy for bladder cancer were not shown to have increased risk of urinary tract infection (UTI) or urine leak compared with patients whose stents were removed later.

The investigators found a postoperative UTI rate of 10.8% for patients in the early stent removal group compared with 10.2% for those in the late removal group.

The investigators found a postoperative UTI rate of 10.8% for patients in the early stent removal group compared with 10.2% for those in the late removal group.

The data were presented by Jessica Wenzel, MD, MPH, during a moderated poster session at the 2023 American Urological Association Annual Meeting in Chicago, Illinois.1 Wenzel is a urology resident at Oregon Health & Science University in Portland.

“Antibiotic prophylaxis reduces the rate of UTI following radical cystectomy. This is typically continued throughout the duration of ureteral stenting. However, the optimal duration of antibiotic prophylaxis as well as ureteral stenting has not yet been determined. At our institution, we used a [quality improvement] protocol to first decrease overall antibiotic duration from the more standard 30 days, and then we further decreased it along with ureteral stent decrease,” Wenzel explained during the presentation.

For the study, data were retrospectively obtained on patients who underwent radical cystectomy between 2016 and 2022.

This yielded 221 patients, of whom 33% had early stent removal (defined as <14 days postoperatively) and 67% had late stent removal (defined as >14 days postoperatively). The average day of stent removal for the patients with early removal was 8.0, compared with 19.9 for patients in the late removal cohort. Primary outcomes were incidence of UTI and urine leak.

Findings showed that patients in the early stent removal group had a lower antibiotic exposure compared with those in late stent removal group (10 vs 21 days, P ≤ .05).

The investigators also found a postoperative UTI rate of 10.8% for patients in the early stent removal group compared with 10.2% for those in the late removal group (P = .9). Rates of urine leak were also similar among the groups, with the early removal cohort experiencing a 0% rate of urine leak compared with 1.3% for the late removal cohort (P = .31).

Mean length of stay was 5.5 days for the early removal group and 5.7 days among the late removal group. Rates of 30-day readmission were 9.3% for the early removal group compared with 11.3% for the late removal cohort. Bowel complications were not analyzed.

Reference

1. Wenzel J, Bassale S, Jones P, et al. Early stent removal after radical cystectomy. Presented at: American Urological Association Annual Meeting, April 28-May 1, Chicago. Abstract MP32-06.

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