Effect of systemic enzyme therapy on the incidence of stentassociated infectious complications in female patients with urolithiasis: a multicentre study

Introduction. It is well established that women experience a more pronounced decline in quality of life after the onset of urinary tract stone disease (urolithiasis), and that the rate of sepsis following ureteroscopic procedures is higher in this patient group.

Objective. To evaluate the effectiveness of systemic enzymotherapy in the prevention of infectious complications after ureteral stenting and subsequent contact laser ureterolithotripsy.

Materials & methods. This comparative, prospective, randomised clinical trial was conducted at four hospitals in Moscow. The final analysis included a cohort of 100 female patients who underwent ureteroscopic interventions following preoperative internal drainage of the upper urinary tract between October 2024 and May 2025. Patients were allocated to two groups: group 1 (n = 61) received Furamag® and systemic enzymotherapy (Wobenzym®) starting from stent placement, with the same treatment regimen repeated after the ureteroscopic procedure; group 2 (n = 39) received monotherapy with the antimicrobial agent Furamag® alone.

Results. At the time of repeat hospitalisation prior to lithotripsy, the main group had a significantly lower prevalence of leukocyturia and bacteriuria (p = 0.001). The need for preoperative antibiotic therapy, including the ambulatory phase, was 4.4-fold lower in women in the main group. Culture of the ureteral stent showed that absence of pathogen growth was more common in the main group. When growth was detected, the microbial titre was predominantly in the range of 10¹ to < 10⁴ CFU/mL (p = 0.001). The addition of Wobenzym® significantly reduced stent biofilm formation by a factor of 4.5.

Conclusion. In women with preoperative internal drainage of the upper urinary tract, incorporating Wobenzym® into combined therapy reduces leukocyturia, bacteriuria, and stent biofilm formation, thereby decreasing the need for antimicrobial therapy.

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