Abstract
Purpose
To evaluate the influence of biofilms on morbidity associated with short-term ureteral stenting using contemporary methods of biofilm examination and validated assessment of symptoms.
Methods
Patients undergoing temporary ureteral stenting for secondary ureterorenoscopy due to urinary calculi were prospectively included. The German Ureteral Stent Symptoms Questionnaire (USSQ) was used to assess stent-associated morbidity. Biofilms were removed from stents using ‘pinhole extraction’, a novel, validated, abrasion-based technique. Extracted biofilms were analyzed for total mass, bacterial load and mineral components. Correlation between total biofilm mass and USSQ total score was the primary outcome variable analyzed using Spearman correlation. Secondary outcomes included correlations between various biofilm characteristics and symptoms.
Results
94 patients were included in the analysis. Extracted biofilm mass had a median of 37.0 mg (0–310.2 mg) per stent. No correlation between total biofilm mass and USSQ total score was found (Spearman r = 0.012; p = 0.911). Correlations between biofilm characteristics and morbidity were generally weak and not significant. Significant correlations could be found between biofilm mass and hematuria (r = 0.280; p = 0.007), and between the number of bacteria (qPCR) and the USSQ subscore for pain (r = 0.243; p = 0.019) and the intake of analgesics (r = 0.259; p = 0.012).
Conclusion
Based on elaborated biofilm examination methods and validated self-reported outcome measures, our findings indicate that biofilms might aggravate some lower urinary tract symptoms but are not the main trigger for stent-associated morbidity in short-term ureteral stenting.
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Acknowledgements
The authors would like to thank Alistair Reeves for editing the manuscript, Luzia Wiesli for technical assistance, and Antonia Neels for support with XRD analyses.
Funding
The study was supported by an internal grant of Cantonal Hospital St. Gallen and the Swiss Federal Laboratories for Materials Science and Technology (Empa/KSSG 15/12).
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PB protocol/project development, data collection and management, data analysis, manuscript writing. VZ protocol/project development, data collection and management, data analysis, manuscript writing. MTB protocol/project development, data collection and management, data analysis, manuscript writing. WCA protocol/project development, data analysis, manuscript writing. ON protocol/project development, data analysis, manuscript writing. SG data analysis, manuscript writing. H-PS protocol/project development, manuscript writing. QR protocol/project development, data analysis, manuscript writing. DA protocol/project development, data collection and management, data analysis, manuscript writing.
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All procedures performed involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Betschart, P., Zumstein, V., Buhmann, M.T. et al. Influence of biofilms on morbidity associated with short-term indwelling ureteral stents: a prospective observational study. World J Urol 37, 1703–1711 (2019). https://doi.org/10.1007/s00345-018-2569-z
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DOI: https://doi.org/10.1007/s00345-018-2569-z