Significance of Indwelling Time for Bacterial Colonization of Double J Stents

Abstract

Objectives: To determine the significance of indwelling time for bacterial colonization of DJ stents by measuring the frequency of bacterial colonization in such stents after endoscopic Urological surgery. Place And Duration: Study was done from September 2014 to November 2015 (15 months) in Department of Urology and Kidney Transplantation, Allied Hospital, Faisalabad. Methodology: 68 patient were included in the study who undergone Percutaneous nephrolithotomy (PCNL) and Ureterorenoscopy (URS) for renal and ureteric stones respectively with DJ stenting. Sterile nature of urine was assured in pre-operative circumstances and patients with active urinary tract infection were excluded from the study. Urinary cultures were performed at 2-4 weeks, 5^th week and more than 6^th week of indwelling time and lower end of DJ stent cultures were also performed after removal. Results: 68 patients were included in the study with mean age 48.5 years (20-77 years age limits). Among 68, 38 were male patients and 30 were female. Percutaneous nephrolithotomy (n = 5) and ureterorenoscopy (n =63) were the procedures after which DJ stenting was performed. Out of 68, 36 patients undergone right sided stenting and 32 patients undergone left side ureteric stenting. Urine culture was positive in 1 (1.47%) case and DJ stent cultures were positive for bacterial colonization in 4 (5.8%) cases. We do not found any statistical association between stent culture analysis and variables like gender, age of patient, or laterality. However we find statistical significance between stent indwelling time and colonization as evident by the results that the rate of colonization was 2.7% when indwelling time was less than 4 weeks, 4% colonization when indwelling time was 5 weeks as compared to 28.5% colonization when indwelling time was more than 6 weeks. Conclusion: These results showed that colonization rates increases when indwelling time increases especially when indwelling time exceeds 6 weeks. This study also refers to the fact that DJ stents can be kept safely for maximum duration of 6 weeks and indwelling time greater than 6 weeks will be associated with complication of urinary tract infection. Moreover this study also showed that one may find an infected colonized stents even if urine culture is negative for any growth.