Ureteral stents with extraction strings - a review on infection risk and prevention.

Introduction: This review aims to determine whether the use of ureteral stents with extraction strings in adult patients undergoing upper urinary tract endoscopic procedures results in a higher incidence of urinary tract infections (UTIs) compared to stents without strings. Material and methods: A systematic literature search was conducted using PubMed, Scopus, and Google Scholar. Studies evaluating differences in UTI rates among adult patients with ureteral stents with or without extraction strings were included. Data on UTI rates, antibiotic prophylaxis protocols, and stent dwell time were extracted. Results: The review included 11 trials published between 2015 and 2023. One multicenter retrospective study involving 4,392 patients reported a significantly higher UTI rate in patients with extraction strings (2.1% vs 1.1%, p = 0.006). In the remaining 10 studies, including four randomized controlled trials, the differences were not statistically significant. Antibiotic prophylaxis was described in five studies. In two studies, a single perioperative antibiotic dose was administered, with a total UTI rate of 6.8% (28/410). In contrast, three studies using prolonged prophylactic antibiotic regimens reported a total UTI rate of 3.2% (13/403). The impact of stent dwell time on UTI risk could not be determined. The risk of bias was high in 10 studies and moderate in one retrospective study. Conclusions: Based on low-quality evidence, the difference in UTI risk between ureteral stents with and without extraction strings appears to be minimal and statistically insignificant. Well-designed studies with standardized methodologies are needed to clarify these findings.