Frequency of urinary tract infections following flexible cystoscopy for double J stent removal in post-transplant patients and characterization of causative agent
DOI:
https://doi.org/10.59736/IJP.23.04.990Keywords:
Cystoscopy, Double J Stent, Post Transplant, Urinary Tract InfectionAbstract
Background: After a cystoscopy, the incidence of asymptomatic bacteriuria ranges from 2.8% to 21%. Since our hospital performs flexible cystoscopy, the purpose of this study is to ascertain the frequency and prevalence of UTIs after cystoscopy with stent removal, identify the primary causative agents, and identify areas for care improvement.
Methods: This descriptive case series study was conducted from July 2024 to July 2025, Patients of either gender between the ages of 18 and 70, have had kidney transplantation and Double J stent in situ with negative urine culture were included. Excluded were any history of urethral instrumentation within the previous week, fever and dysuria on the day of the cystoscopy, diabetes mellitus, and antibiotic use within the previous week. A consultant urologist with at least five years of expertise in the field, performed flexible cystoscopy on all individuals under local anesthesia for the removal of DJS and to maintain sterility. Urine microscopy and urine dipsticks were used to confirm the presence of a urinary tract infections in the collected midstream urine sample, and urine culture was used to determine the causative agent.
Results: The study's participants ranged in age from 18 to 70, with a mean age of 35.99 ± 11.48 years. With a male to female ratio of 1.4:1, 62 (57.94%) of the 107 patients were men and 45 (42.06%) were women. Urinary tract infections following flexible cystoscopy for double j stent (DJS) removal in post-transplant patients was found in 10 (9.35%) patients. The most common uropathogens encountered in UTIs after cystoscopy are Escherichia coli60.0%), Proteus (20.0%), and Klebsiella (20.0%).
Conclusion: We concluded that 9.35% of post-transplant patients get UTIs after flexible cystoscopy for the removal of a DJS.
References
Bharuka V, Meshram R, Munjewar PK. Comprehensive review of urinary tract infections in renal transplant recipients: clinical insights and management strategies. Cureus. 2024;16(2): e53882.
Burke DM, Shackley DC, O'reilly PH. The community‐based morbidity of flexible cystoscopy. BJUI. 2002; 89(4):347-9.
Safiullah S, Lama DJ, Patel R, Clayman R V. Procedural module: flexible cystoscopy. J Endourol. 2018;32(S1) :S-2.
Solanki N, Dash SC, Handa A, Singh G, Mahajan P, Khandelwal S. Clinical Significance of DJ stent culture in patients with indwelling ureteral stents prior to endourological intervention- a single centre prospective cohort study. J Clin Diagnos Res. 2021;15(4): PC01-PC05.
Cusumano JA, Hermenau M, Gaitanis M, Travis M, LaPlante KL, Tran TY, et al. Evaluation of post–flexible cystoscopy urinary tract infection rates. AJHP. 2020; 77(22):1852-8.
Yang X, Chen H, Zheng Y, Qu S, Wang H, Yi F. Disease burden and long-term trends of urinary tract infections: a worldwide report. Front Public Health. 2022; 10:888205.
Gregg JR, Kang CL, Talbot TR, Moore D, Herrell SD, Dmochowski R, et al. Symptomatic urinary tract infections in renal transplant recipients after cystoscopy for ureteral stent removal. Urol Pract. 2017;4(5):405–11.
Sharma S, Sharma N. Urinary tract infection in renal transplant recipients: Incidence, microbiological profile and predisposing factors in India. Transplant Proc. 2023; 55:1310–1311.
Suárez Fernández ML, Ridao Cano N, Álvarez Santamarta L, Gago Fraile M, Blake O, Díaz Corte C. A current review of the etiology, clinical features, and diagnosis of urinary tract infection in renal transplant patients. Diagnostics (Basel) 2021; 11:1456.
Boeykens M, Keller EX, Bosio A, Wiseman OJ, Contreras P, Ventimiglia E, et al. Impact of ureteral stent material on stent-related symptoms: a systematic review of the literature. Eur Urol Open Sci. 2022; 45:108–17.
Abu S, Asaolu SO, Igbokwe MC, Olatise OO, Obiatuegwu K, Onwuasoanya UE, et al. Bacterial Colonization in Double J Stent and Bacteriuria in Post-Renal Transplant Patients. Cureus. 2022;14(7): e27508.
Ranganathan M, Akbar M, Ilham MA, Chavez R, Kumar N, Asderakis A. Infective complications associated with ureteral stents in renal transplant recipients. Transplant Proc 2009; 41:162-4.
Ashraf HS, Khan MU, Hussain I, Hyder I. Urological complications in ureteric stenting live related renal transplantation. J Coll Physicians Surg Pak 2011; 21:34-6.
Mathe Z, Treckmann JW, Heuer M. Stented ureterovesical anastomosis in renal transplantation: Does it influence the rate of urinary tract infections? Eur J Med Res 2010; 15:297-302.
Derouich A, Hajri M, Pacha K, Ben Hassine L, Chebil M, Ayed M. Impact of the use of double J stents in renal transplantation on incidence of urologic complications and urinary infection. Prog Urol 2002; 12:1209-12.
Tavakoli A, Surange RS, Pearson RC, Parrott NR, Augustine T, Riad HN. Impact of stents on urolo- gical complications and health care expenditure in renal transplant recipients: Results of a pros- pective, randomized clinical trial. J Urol 2007;177: 2260-4.
Kehinde EO, Rotimi VO, Al-Hunayan A, Abdul-Halim H, Boland F, Al-Awadi K. Bacteriology of urinary tract infection associated with indwelling J ureteral stents. J Endourol. 2004; 18:891–6.
Joshi HB, Stainthorpe A, Keeley FX, MacDonagh R, Timoney AG. Indwelling ureteral stents: evaluation of quality of life to aid outcome analysis. J Endourol 2001; 15:151-4.
Reid G, Denstedt JD, Kang YS, Lam D, Nause C. Microbial adhesion and biofilm formation on ureteral stents in vitro and in vivo. J Urol 1992; 148:1592- 4.
Reddy VVV, Repaka AK, Ramadugu RV, Vasa AK. A study on correlation of microbial culture of stent and symptomatology in patients with lower urinary tract symptoms (luts) after dj stenting. Int J Acad Med Pharm 2023;5(5):1201-7.
Wood SJ, Kuzel TM, Shafikhani SH. Pseudomonas aeruginosa: infections, animalmodeling, andtherapeutics.Cells.2023; 12:199. doi: 10.3390/cells12010199.
Krawczyk B, Wysocka M, Michalik M, Gołębiewska J. Urinary tract infections caused by K. pneumoniae in kidney transplant recipients - epidemiology, virulence and antibiotic resistance. Front Cell Infect Microbiol. 2022; 12:861374.
Govindarajan DK, Kandaswamy K. Virulence factors of uropathogens and their role in host pathogen interactions. Cell Surf. 2022; 8:100075.
Hosseinpour M, Pezeshgi A, Mahdiabadi MZ, Sabzghabaei F, Hajishah H, Mahdavynia S. Prevalence and risk factors of urinary tract infection in kidney recipients: a meta-analysis study. BMC Nephrol. 2023; 24:284.
Nevo A, Mano R, Schreter E, Lifshitz DA. Clinical implications of stent culture in patients with indwelling ureteral stents prior to ureteroscopy. J Urol 2017; 198:116-21.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Muhammad Shoaib Khan, Ikram Ullah, Murad Ali, Maaz Khan, Idrees Ismail, Misbah Ur Rahman
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
