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Passive ureteral dilation secondary to ureteral stenting and

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Title: Passive ureteral dilation secondary to ureteral stenting and
Author: Vachon, Catherine
Department: Department of Clinical Studies
Program: Clinical Studies
Advisor: Defarges, Alice
Abstract: In children, passive ureteral dilation occurs after placement of a ureteral stent.Hubert 2005 The objectives of the thesis were to determine if passive ureteral dilation occurs in dogs after stent placement, and if ureteroscopy is feasible. The second part of the thesis evaluated biofilm production. In five healthy beagles, bilateral stent were placed. One stent was removed after two weeks (group 1) and the contralateral stent was removed after 6 weeks (group 2). A CT excretory urography was performed every 2 weeks for 10 weeks to measure the ureteral diameter. Ureteroscopy was attempted at the time of stent removal. Urinalysis and urine culture were performed every two weeks. The stent removed aseptically were evaluated for adhered bacteria using sonication and scanning electron microscopy. Also, seventy enterococci clinical isolates previously isolated were studied in vitro using microtitre plate assay. A repeated measures ANOVA as well as descriptive statistics were performed. Passive ureteral dilation occurred. Median ureteral diameter was 1.65 mm (range 1.3-2.7 mm) prior to stenting in both groups. At stent removal, ureteral diameter was 2.9 mm (2.4-3.1 mm, p<0.0001) in group 1 and 2.7 mm (2.1-3.4 mm, p=0.0016) in group 2. Ureteroscopy was successfully performed up to the renal pelvis in all dogs without any evidence of complications. Pyuria and positive urine culture were detected in 3 of 30 (10%) and 5 of 30 (17%) samples collected, respectively. None of the dogs had signs of lower urinary tract infection. After sonication, there was no growth noted from any stents at week 2 but bacteria were identified at week 6. Scanning electron microscopy failed to identify bacteria. Of the seventy enterocci isolates tested, 42/70 (53%) produced biofilm; 20/23 (87%) were E. faecalis and 16/47 (34%) were E. faecium. Biofilm production was common, especially for the E. faecalis isolates. In conclusion, passive ureteral dilation occurs within 2 weeks of ureteral stent placement. Ureteroscopy can be performed at stent removal. Bacteriuria may occur within few weeks following stent placement. Lastly, enterococcal isolates produced biofilm, especially Enterococcus faecalis.
Date: 2016-07
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