title: Microbial colonization and ureteral stent-associated storage lower urinary tract symptoms: the forgotten piece of the puzzle?
abstract: OBJECTIVE
  Ureteral stents are frequently associated with side effects. Most patients suffer from storage lower urinary tract symptoms (LUTS). Storage LUTS are commonly attributed to the irritation of the trigone, smooth muscle spasm or a combination of factors. The relationship between microbial ureteral stent colonization (MUSC) and de novo or worsening storage LUTS has not been investigated yet.
  
  
  METHODS
  Five hundred ninety-one polyurethane ureteral stents from 275 male and 153 female patients were prospectively evaluated. The removed stents were sonicated to dislodge adherent microorganisms. Urine flow cytometry was performed to detect pyuria. A standardized urinary symptom questionnaire was given to all patients.
  
  
  RESULTS
  Thirty-five per cent of male and 28% of female cases showed de novo or worsened storage LUTS. MUSC was more common in patients with storage LUTS compared to patients without storage LUTS (men: 26 vs. 13%, respectively, P < 0.05; women: 63 vs. 48%, respectively, P = 0.13). Pyuria was significantly more common in patients with storage LUTS compared to patients without storage LUTS (men: 55 vs. 40%, respectively, P < 0.05; women: 70 vs. 45%, respectively, P < 0.05). No significant correlation was observed between the detected genera of microorganisms and storage LUTS.
  
  
  CONCLUSIONS
  Our data show a significant association between MUSC- and stent-related de novo experienced or worsened storage LUTS in men. The incidence of MUSC is most common in both female and male patients with storage LUTS and accompanying pyuria. In these patients, a combination of antibiotics and anti-inflammatory drugs may be regarded as treatment option.
authors.affiliation: Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. bonkatg@uhbs.ch
authors.forename: Gernot
authors.initials: G
authors.lastname: Bonkat
authors.forename: Malte
authors.initials: M
authors.lastname: Rieken
authors.forename: Georg
authors.initials: G
authors.lastname: Müller
authors.forename: Alexander
authors.initials: A
authors.lastname: Roosen
authors.forename: Fabian P
authors.initials: FP
authors.lastname: Siegel
authors.forename: Reno
authors.initials: R
authors.lastname: Frei
authors.forename: Stephen
authors.initials: S
authors.lastname: Wyler
authors.forename: Thomas
authors.initials: T
authors.lastname: Gasser
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015169:Colony Count, Microbial; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D015994:Incidence; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011776:Pyuria / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D012189:Retrospective Studies; D012737:Sex Factors; D013210:Staphylococcus / Q000302:isolation & purification*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D062885:Urinary Catheters / Q000009:adverse effects / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents