The pressing need for the improvement of stent materials to reduce the infective complications, as well as, the causal relationship between stone removal and prevention of recurrent urinary tract infections (rUTIs) are some of the topics examined and deliberated during the Thematic Session 05: Infections chaired by Ass. Prof. Andreas Neisius (DE) and Dr. Christian Türk (AT).
To treat or not to treat?
In his lecture “Does stone removal really prevent recurrent UTIs?” by Dr. Andreas Bourdoumis (GR) said “It appears that larger and/or multiple stones per se are more likely to be created and cause UTI than small/solitary calculi.”
According to Bourdoumis, the risk factor stratification comprises of E. coli rUTIs, hypertension, African American ethnicity, infection stones, anatomical abnormalities, neuropathic lower urinary tract (LUT), obstructed LUT, and special risk groups.
With regard to special risk groups, treatment is recommended for children, patients who have undergone kidney transplant, and urinary diversion. “With pregnant patients, it’s a different story,” said Bourdoumis. He cited the EAU Recommendation to “Treat all uncomplicated cases of urolithiasis in pregnancy conservatively (except those that have clinical indications for intervention).”
Bourdoumis said to “treat symptomatic and special risk groups pre-emptively.” And as prevention, there should be complete stone clearance and antibiotic prophylaxis guided by stone culture and microbiologist guidance.
DESs, the future of stents?
According to Dr. Panagiotis Kallidonis (GR), drug-eluting stents (DESs) have a high potential to reduce the incidence of infectious complications of ureteral stents. In his lecture “Drug-eluting stents: Concept, evidence and future” he said that there are favorable experience with DESs in the fields of interventional radiology and cardiology in comparison to conventional metal stents. He added that “There is a technology that incorporates drugs in the matrix of the polymeric stents (PSs) or metal stents (MSs). These drugs will be released in time over a controlled fashion.”
Kallidonis said “We are aiming to look for a specific drug that could allow us to reduce the complications of PSs and MSs stents. He stated that designing DESs is composed of three components: Platform, coating and pharmacological agent.
“It is important to have the protection of an appropriate stent for the urinary tract if we want to have good results. Although we are currently far from adequately documenting the DESs for the use in the urinary tract, this would possibly improve in the future.”