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| Home > Publications database > Antimicrobial strategies for ureteral stent removal after radical cystectomy: a comparative cohort study. |
| Journal Article | DKFZ-2026-01060 |
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2026
Springer
New York
Abstract: Introduction:Patients undergoing radical cystectomy (RC) face a heightened risk of infectious complications around the time of ureteral stent removal. This study aimed to determine whether a culture-guided antimicrobial strategy reduces infectious complications after stent removal compared with an empirical nitrofurantoin regimen.Methods:We analyzed 200 patients who underwent RC with urinary diversion and ureteral stenting. Patients received either empirical nitrofurantoin or a culture-guided antimicrobial strategy based on pre-removal urine cultures for stent removal. The primary endpoint was the incidence of early systemic urinary tract infection (UTI) within 48 h after stent removal. Secondary endpoints included changes in inflammatory markers, hydronephrosis after stent removal, and UTI-related readmissions within 30 and 90 days.Results:Early systemic UTIs occurred in 4% of patients receiving empirical nitrofurantoin and 7% in the culture-guided group (OR 0.56, 95% CI 0.12-2.27; p = 0.54). UTI-related readmissions at 30 and 90 days were similar between regimens (1% vs. 2%, p = 0.99; 5% vs. 9%, p = 0.41). An early leukocyte rise was associated with early systemic UTI after stent removal (2.65 vs. 0.51 × 10⁹/L; p = 0.048). Pre-removal urine cultures frequently yielded non-classical uropathogens consistent with stent-associated colonization, potentially limiting the clinical utility of routine culture-guided escalation. The culture-guided strategy did not reduce early infectious complications despite the use of broader-spectrum agents.Conclusion:Empirical nitrofurantoin and a culture-guided antimicrobial strategy showed similar rates of early systemic UTIs and UTI-related readmissions after ureteral stent removal in patients undergoing RC. Routine culture-guided escalation may therefore offer limited clinical benefit while increasing antimicrobial exposure. Prospective multicenter trials are warranted to define optimal procedure-specific strategies.
Keyword(s): Antimicrobial Strategies ; Radical Cystectomy ; Ureteral Stent Removal ; Urinary Diversion
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