Journal of pediatric urology · 2026
The impact of intravesical Double-J stent configuration and dwell time on significant urine culture positivity in pediatric patients.
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Genisol Incinur, Okur Ozkan, Can Mehmet, Ok Tila, Sencan Arzu
Аннотация
BACKGROUND: Double-J (DJ) stents are widely used in pediatric urology; however, stent-related urinary tract infection (UTI) remains a significant source of morbidity. Although prolonged indwelling time is a recognized risk factor, the impact of intravesical distal coil configuration on infection risk has not been systematically evaluated in pediatric cohorts.
METHODS: This retrospective, single-center cohort study included 144 pediatric patients (<18 years) who underwent unilateral DJ stent placement following pyeloplasty for ureteropelvic junction obstruction (UPJO) or after endourological intervention for ureteral calculi between 2015 and 2025. Stent dwell time, deviation from the age-based "age +10" formula, and distal coil trigonal position on postoperative imaging records (ipsilateral vs contralateral extension) were analyzed. The primary outcome was significant urine culture positivity before DJ stent removal.
RESULTS: Median stent dwell time was significantly longer in patients with significant urine culture positivity compared with those without culture positivity (38.5 days [IQR 28.25-55.25] vs 27.5 days [IQR 21.25-36.75], p < 0.001). Contralateral trigonal extension of the distal coil was associated with a higher rate of significant urine culture positivity compared with ipsilateral positioning (48.7% vs 27.6%; OR 2.49, 95% CI 1.16-5.32; p = 0.017). In multivariable logistic regression analysis, stent dwell time (OR 1.028, 95% CI 1.004-1.052; p = 0.021), contralateral trigonal extension (OR 3.35, 95% CI 1.23-9.12; p = 0.018), and pyuria (OR 10.30, 95% CI 3.31-32.03; p < 0.001) remained independently associated with significant urine culture positivity. Stent length mismatch was not directly associated with infection (p = 0.662). However, longer-than-expected stents were more frequently associated with contralateral trigonal extension (p = 0.012).
CONCLUSION: These findings suggest that prolonged stent dwell time is consistently associated with significant urine culture positivity. The observed association between contralateral trigonal extension and culture positivity should be interpreted cautiously and requires confirmation in prospective studies.
METHODS: This retrospective, single-center cohort study included 144 pediatric patients (<18 years) who underwent unilateral DJ stent placement following pyeloplasty for ureteropelvic junction obstruction (UPJO) or after endourological intervention for ureteral calculi between 2015 and 2025. Stent dwell time, deviation from the age-based "age +10" formula, and distal coil trigonal position on postoperative imaging records (ipsilateral vs contralateral extension) were analyzed. The primary outcome was significant urine culture positivity before DJ stent removal.
RESULTS: Median stent dwell time was significantly longer in patients with significant urine culture positivity compared with those without culture positivity (38.5 days [IQR 28.25-55.25] vs 27.5 days [IQR 21.25-36.75], p < 0.001). Contralateral trigonal extension of the distal coil was associated with a higher rate of significant urine culture positivity compared with ipsilateral positioning (48.7% vs 27.6%; OR 2.49, 95% CI 1.16-5.32; p = 0.017). In multivariable logistic regression analysis, stent dwell time (OR 1.028, 95% CI 1.004-1.052; p = 0.021), contralateral trigonal extension (OR 3.35, 95% CI 1.23-9.12; p = 0.018), and pyuria (OR 10.30, 95% CI 3.31-32.03; p < 0.001) remained independently associated with significant urine culture positivity. Stent length mismatch was not directly associated with infection (p = 0.662). However, longer-than-expected stents were more frequently associated with contralateral trigonal extension (p = 0.012).
CONCLUSION: These findings suggest that prolonged stent dwell time is consistently associated with significant urine culture positivity. The observed association between contralateral trigonal extension and culture positivity should be interpreted cautiously and requires confirmation in prospective studies.