Bridging the knowledge gap: past, present and future of antibiotic use for ureteral stents.

OBJECTIVE: To evaluate the available literature on ureteric stent-related infections, the use of antibiotics and bacterial colonisation to identify the current incidence of stent-related infections, unveil knowledge gaps and generate potential hypotheses for future research. METHODS: A literature review was conducted using PubMed, Cochrane and urological association websites identifying relevant English literature published between 1983 and January 2024. RESULTS: There is a worldwide lack of guidelines for antibiotic prophylaxis for stent placement, exchange or extraction. In patients with a negative preoperative urine culture undergoing ureteroscopy and stent placement, it may be considered to only provide prophylaxis in presence of risk factors. However, in pre-stented patients a preoperative urine culture is important to guide prophylaxis during endourological surgery. During stent indwell time, antibiotic prophylaxis does not show any advantage in preventing urinary tract infections (UTIs). There is no strong evidence to support the use of antibiotics at time of stent removal. In the absence of any clear evidence, management strategies for treating UTIs in patients with ureteric stents vary widely. Stent exchange could be considered to remove the biofilm as a potential source of bacteria. Stent culture can help to guide treatment during infection as urine culture and stent culture can differ. CONCLUSION: In terms of good antibiotic stewardship, urologists should be aware that unnecessary use of antibiotics provokes bacterial resistance. There is a great need for further research in the field of antibiotic prophylaxis and stent-related infections to develop evidence that can help shape clear guidelines for this very common urological practice.

Sigmoid perforation by broken nitinol memory frame after inguinal hernia repair.

INTRODUCTION: For an inguinal hernia repair, meshes with a continuous memory frame made it more easy to position the mesh in the preperitoneal space by anterior approach. We present a case of a sigmoid perforation caused by a fractured nitinol ring of a Rebound HRD Shield mesh. PATIENTS AND METHODS: A 29-years old sports instructor presented to the Emergency Department (ED) with a gnawing abdominal pain in the left lower quadrant. His past medical history noted an inguinal hernia repair on this side. A computed tomography scan showed a broken metal ring of the inguinal mesh perforating the sigmoid, so a laparoscopy was performed. The sigmoid was attached to the abdominal wall partially overlying the preperitoneal mesh and a part of the broken nitinol frame was found perforating the colon. RESULTS: The memory ring of the Rebound mesh is made of nitinol. An alloy well-known in vascular surgery for stenting arteries with high bending and compression forces. In this setting, fracture due to fatigue has already been described, but it is not known in abdominal wall reconstruction. Our patients groin was subject to daily bending and compression forces resulting in breakage of the nitinol ring. CONCLUSION: Particularly in young athletic patients the nitinol ring will be subject to bending forces in the groin and prone to breakage. This can have potentially severe consequences given its location near abdominal organs and neurovascular structures. In our opinion, patients should be informed about the possibility of ring breakage and doctors should consider the risk-benefits well.

Exercise performance and quality of life in children with cystic fibrosis and mildly impaired lung function: relation with antibiotic treatments and hospitalization.

This study evaluates the impact of antibiotic treatments and hospitalization on exercise performance and health-related quality of life (QOL) in children with mild cystic fibrosis (CF) lung disease. Forty-seven children between 7 and 17 years with mild CF underwent a maximal exercise test including spiro-ergometry and filled out a QOL-questionnaire (PedsQL™). Amount of antibiotic treatments (AB) and hospitalization days in the last 3 years were reviewed. FEV1% was mildly decreased (91.7 ± 17.9 L/min, p = 0.02). Maximal oxygen consumption (VO2max), test duration and anaerobic threshold were lower compared to a control population (VO2max% 94 ± 15 vs 103 ± 13, p = 0.009). FEV1% correlated with AB and hospitalization episodes in the last year and 3 years before testing, VO2max% only correlated with AB in the last 3 years. Domains of school functioning and emotional functioning were low. Children with higher VO2max% and less AB in the last 3 years had better physical health. Physical health and school functioning were negatively correlated with hospitalization days in the last year. CONCLUSION: Patients with mild CF lung disease have good exercise performance although still lower than the normal population. VO2max% is affected by number of antibiotic treatments over a longer period. There is an impact of hospitalization days on quality of life. What is Known: • Children with CF have lower exercise performance; there is an association between hospitalization frequency and exercise performance • Quality of life is diminished in children with CF and influenced by respiratory infections What is New: • Even patients with mild CF lung disease have lower maximal exercise performance (VO 2 max) and a lower anaerobic threshold; VO 2 max is lower in children who had more antibiotic treatments in the last 3 years • School and emotional functioning are diminished in children with mild CF lung disease; hospitalization is negatively correlated with school functioning and physical functioning.