Do Ureteral Stent Extraction Strings Increase the Risk of UTI in Children after Robotic Ureteral Reconstruction?
Shane Forest Batie, MD, Caitlin Coco, MD, Shreedhar Reddy, MD, Jennifer Tracy, FNP, Janelle Traylor, FNP, Karen Pritzker, FNP, Yvonne Chan, MD, Irina Stanasel, MD, Micah Jacobs, MD, Bruce Schlomer, MD, Linda Baker, MD, Craig Peters, MD.
University of Texas Southwestern, Dallas, TX, USA.
Do Ureteral Stent Extraction Strings Increase the Risk of UTI in Children after Robotic Ureteral Reconstruction?Background: Ureteral stents facilitate recovery and avoid external drains in pediatric robotic reconstructive procedures. Extraction strings avoid the need for a secondary cystoscopy and anesthetic. Due to concerns regarding febrile UTIs in children with extraction strings, we retrospectively assessed the relative risk of UTI in children with extraction strings.
Methods: Records of all children undergoing robotic pyeloplasty and ureteroureterostomy (UU) from 2014 to 2021 were reviewed under IRB protocol. The incidences of UTI, fever, and hospitalization were recorded.
Results: 235 patients were identified (219 pyeloplasty; 16 UU - mean age: 6.6 years). Stents with extraction strings were removed at 2-3 weeks post-op while others underwent cystoscopic removal 4 weeks post-op. 49 patients had an extraction string. Of these, 9 (18.4%) developed UTI (all febrile) while the stent was in place and required hospitalization, while only 13 (6.6%) of those without extraction string did (p<0.02). Age, sex, and use of prophylactic antibiotics did not affect the incidence of UTI, but prior UTI did. Of the 9 children with a febrile UTI in the extraction string group, 6 had history of prior UTI (46.1%), compared to only 3 (8.3%) without a prior UTI (p<0.05). With no prior UTI there was no difference in UTI risk between those with (3, 8.3%) and without (8, 6.4%) extraction string (p=0.71). In children with a history of prior UTI, use of an extraction string had a higher rate of UTI (6, 46.5%) than those without an extraction string (4, 10.3%) (p=0.01). There were 5 (10%) stent dislodgements in the extraction string group, of which 2 required further intervention with either cystoscopy or percutaneous drainage.
Conclusions: Children with prior history of UTI have a significantly increased risk of febrile UTIs associated with the use of extraction strings. Prophylaxis does not seem to reduce this risk. Patients with no prior UTI had no higher risk of UTI with extraction string use for pyeloplasty or UU. Extraction strings may not be optimal care in those with prior history of UTI. 
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