The use of triclosan eluting stents effectively reduces ureteral stent symptoms: a prospective randomized trial

Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Infection, encrustation and ureteral‐stent‐related symptoms (USRS) including pain, urgency and frequency are all major problems associated with stent use. No current ureteral stent or exogenously applied therapy adequately deals with these problems and antibiotic use is ineffective once a bacterial biofilm forms on the device. Triclosan is a broad spectrum antibacterial agent widely used in numerous healthcare products and has been previously shown to reduce inflammation on the skin and in the oral cavity. This study tested a triclosan‐impregnated ureteral stent for its ability to reduce infection, encrustation and USRS. This study shows that while a triclosan‐impregnated ureteral stent cannot reduce infection rates alone compared with antibiotic use, the stent can reduce several USRS including pain during indwelling. This study suggests that the triclosan eluting stent may have a role in treating patients, perhaps in combination with standard antibiotic therapy.

OBJECTIVE

• ? To evaluate the capacity of triclosan‐loaded ureteral stents to reduce stent‐associated bacterial attachment, biofilm formation and encrustation, thereby potentially reducing infection development and other device‐related sequelae.

PATIENTS AND METHODS

• ? Twenty subjects requiring short‐term stenting (7–15 days) were randomized to receive either a Percuflex Plus® non‐eluting stent (control) or a Triumph® triclosan eluting stent.
• ? Control‐stented subjects received 3 days of levofloxacin prophylaxis (500 mg once daily) while Triumph®‐stented subjects did not.
• ? All subjects were assessed for positive urine and stent cultures, stent biofilm development and encrustation.
• ? Following device removal, each subject completed an analogue‐scale symptom assessment questionnaire.

RESULTS

• ? Ureteral stenting was performed after nine ureteroscopic and one extracorporeal shock wave lithotripsy procedure in the control group and eight ureteroscopic and two shock wave lithotripsy procedures in the triclosan group.
• ? No significant differences were observed for culture, biofilm and encrustation between the two groups.
• ? Subjects in the triclosan group reported significant reductions in lower flank pain scores during activity (58.1% reduction, P= 0.017) and urination (42.6%, P= 0.041), abdominal pain during activity (42.1%, P= 0.042) and urethral pain during urination (31.7%, P= 0.049).

CONCLUSIONS

• ? In this study, the use of the Triumph® triclosan eluting stent had no marked impact on biofilm formation, encrustation or infection development in short‐term stented patients.
• ? The Triumph® device led to significant reductions in several common ureteral‐stent‐related symptoms, supporting its use in this patient population.