Relationship Between Ureteral Stent Dwell Time And UTI
College
College of Health Sciences
Department
Nursing
Graduate Level
Doctoral
Graduate Program/Concentration
Advanced Practice
Presentation Type
No Preference
Abstract
Purpose
This study aimed to determine if there is a relationship between ureteral stent dwell time and the incidence of UTI prior to and after definitive stone surgery. We explored the optimal ureteral stent dwell time following initial placement for obstructing stones prior to definitive stone surgery in an effort to decrease the incidence of UTIs associated with ureteral stent placement.
Problem
Kidney stones are a common problem, with about 8.8% of the United States population affected, this often results in significant discomfort, multiple surgeries, and leads to billions of dollars spent annually.* Ureteral stents are often needed for renal drainage with an obstructed ureter, prior to stone surgery.* Ureteral stents are temporary treatment measures and require eventual removal or exchange, but they are not without risks and often cannot be avoided. There is currently no consensus on recommended ureteral stent length of stay or dwell time.
Methods
A non-experimental, retrospective, correlational design was used to study the effects of a possible cause without the intention of proving causation; there was not any interventions by the researcher. Patients have undergone surgery for both ureteral stent placement and stone surgery- either ureteroscopy (URS) with laser lithotripsy and/or percutaneous nephrolithotomy (PCNL). Data was collected through chart reviews from patients who had undergone surgery in 2022 and pre-stent and pre-lithotripsy urine culture results were collected. Data was analyzed using the SPSS Statistics 28.0 software.
Results
101 adult male and female patients were studied and analyzed using the Pearson/ point-biserial correlation and Chi-Square test. There was a positive correlation between ureteral stent dwell time (stage 1), BMI and stone size when compared to post-stent UTI; this was statistically significant with a p value of 0.01. A Chi-Square test determined there was a positive correlation among patients with CKD as well as those having a pre-stent UTI when compared to post-stent UTI. One could conclude that the longer a ureteral stent remains in place, the higher the BMI, the larger the stone size, those with a diagnosis of CKD or those who had a pre-stent UTI, all have a higher likelihood of developing a UTI. There were no statistically significant association among age, gender, diagnosis of diabetes, surgery type or stone location when compared to post-stent UTI. We were unable to test ureteral stent dwell time (stage 2) and UTI as there were minimal urine cultures collected prior to ureteral stent removal.
Conclusion
The significance in this research highlighted the variables possibly contributing to UTIs related to ureteral stent placement. The knowledge obtained will allow prioritization among patients with ureteral stents requiring kidney stone surgery. Having a consensus with optimal stent dwell time, should improve efficiency and consistency within our practice, help to reduce the incidence of UTIs associated with ureteral stent placement, and possibly reduce hospital readmission for UTIs.
Keywords
UTI, kidney stone, ureteral stone, ureteral stent, surgery, ureteroscopy, laser lithotripsy, percutaneous nephrolithotomy, urology
Relationship Between Ureteral Stent Dwell Time And UTI
Purpose
This study aimed to determine if there is a relationship between ureteral stent dwell time and the incidence of UTI prior to and after definitive stone surgery. We explored the optimal ureteral stent dwell time following initial placement for obstructing stones prior to definitive stone surgery in an effort to decrease the incidence of UTIs associated with ureteral stent placement.
Problem
Kidney stones are a common problem, with about 8.8% of the United States population affected, this often results in significant discomfort, multiple surgeries, and leads to billions of dollars spent annually.* Ureteral stents are often needed for renal drainage with an obstructed ureter, prior to stone surgery.* Ureteral stents are temporary treatment measures and require eventual removal or exchange, but they are not without risks and often cannot be avoided. There is currently no consensus on recommended ureteral stent length of stay or dwell time.
Methods
A non-experimental, retrospective, correlational design was used to study the effects of a possible cause without the intention of proving causation; there was not any interventions by the researcher. Patients have undergone surgery for both ureteral stent placement and stone surgery- either ureteroscopy (URS) with laser lithotripsy and/or percutaneous nephrolithotomy (PCNL). Data was collected through chart reviews from patients who had undergone surgery in 2022 and pre-stent and pre-lithotripsy urine culture results were collected. Data was analyzed using the SPSS Statistics 28.0 software.
Results
101 adult male and female patients were studied and analyzed using the Pearson/ point-biserial correlation and Chi-Square test. There was a positive correlation between ureteral stent dwell time (stage 1), BMI and stone size when compared to post-stent UTI; this was statistically significant with a p value of 0.01. A Chi-Square test determined there was a positive correlation among patients with CKD as well as those having a pre-stent UTI when compared to post-stent UTI. One could conclude that the longer a ureteral stent remains in place, the higher the BMI, the larger the stone size, those with a diagnosis of CKD or those who had a pre-stent UTI, all have a higher likelihood of developing a UTI. There were no statistically significant association among age, gender, diagnosis of diabetes, surgery type or stone location when compared to post-stent UTI. We were unable to test ureteral stent dwell time (stage 2) and UTI as there were minimal urine cultures collected prior to ureteral stent removal.
Conclusion
The significance in this research highlighted the variables possibly contributing to UTIs related to ureteral stent placement. The knowledge obtained will allow prioritization among patients with ureteral stents requiring kidney stone surgery. Having a consensus with optimal stent dwell time, should improve efficiency and consistency within our practice, help to reduce the incidence of UTIs associated with ureteral stent placement, and possibly reduce hospital readmission for UTIs.