Is a Murphy drip used after ureteral stent (ureteric stent) placement in patients, especially those with a history of urinary tract infections (UTIs), kidney disease, or other comorbidities?

Murphy Drip After Ureteral Stent Placement

A Murphy drip (Foley catheter drainage) is not routinely recommended after uncomplicated ureteral stent placement, but should be considered in specific high-risk scenarios including trauma cases with urinoma, patients with complications requiring drainage optimization, or when minimizing collecting system pressure is therapeutically beneficial.

Clinical Context and Terminology

The term "Murphy drip" refers to continuous bladder drainage via a Foley catheter, which can theoretically reduce pressure in the collecting system and enhance drainage around a newly placed ureteral stent. However, this practice lacks strong evidence-based support in routine stent placement scenarios.

When Murphy Drip IS Indicated

Trauma and Complication Management

• In urotrauma patients with ureteral stenting for complications (urinoma, fever, infection), concomitant Foley catheter drainage may minimize pressure within the collecting system and enhance urinoma drainage 1
• The AUA urotrauma guidelines specifically note that "a period of concomitant Foley catheter drainage may minimize pressure within the collecting system and enhance urinoma drainage" when stents are placed for traumatic injuries 1

Bladder Injury Scenarios

• After surgical repair of bladder injuries, urinary drainage with urethral catheter is mandatory in adults (though this is for bladder repair itself, not routine stent placement) 1

When Murphy Drip is NOT Indicated

Routine Ureteroscopy and Stone Management

• Routine placement of a ureteral stent postoperatively does not require concomitant Foley drainage according to EAU, AUA/ES, and SIU/ICUD guidelines for urolithiasis management 1
• The guidelines for surgical stone management make no mention of Murphy drip as standard practice after routine stent placement 1

Renal Transplantation

• In renal transplant recipients with routine stent placement, standard postoperative Foley catheter management applies, but extended "Murphy drip" beyond typical post-surgical bladder drainage is not recommended 2, 3, 4
• The focus in transplant patients is on early stent removal (within 14 days) to reduce infection risk rather than prolonged bladder drainage 2

Critical Risk Factors to Consider

Infection Risk with Prolonged Catheterization

• Postoperative Foley catheterization for >5 days is an independent risk factor for bacteriuria (OR 4.7) 4
• Female gender, diabetes mellitus, chronic renal failure, and diabetic nephropathy significantly increase infection risk with indwelling devices 5
• The bacteriuria rate increases from 4.2% for stents <30 days to 34% for stents >90 days 5

Urosepsis Management Caveat

• In patients with existing stents who develop urosepsis, do not routinely exchange the stent during acute sepsis unless it is the source of obstruction 6
• If percutaneous nephrostomy is placed for urosepsis, consider removing the existing stent once stabilized, as concomitant use of multiple urinary devices increases infection risk 6

Evidence-Based Recommendation Algorithm

Use Murphy drip (extended Foley drainage) after stent placement ONLY if:

1. Trauma scenario with urinoma or collecting system injury requiring pressure minimization 1
2. Complications present (fever, enlarging urinoma, infection) where enhanced drainage is therapeutic 1
3. Bladder injury repair where mandatory catheter drainage is part of bladder management 1

Do NOT use routine Murphy drip for:

1. Uncomplicated ureteroscopy with stent placement 1
2. Routine stone management procedures 1
3. Standard renal transplant stent placement (use only standard post-op catheter duration) 2, 3

Common Pitfalls to Avoid

• Do not prolong Foley catheterization beyond 5 days without specific indication, as this significantly increases bacteriuria risk 4
• Do not assume Murphy drip compensates for poor stent function—if drainage is inadequate, consider percutaneous nephrostomy instead 1
• In diabetic patients and those with chronic kidney disease, minimize all indwelling device duration due to markedly elevated infection risk 5
• Retained stents pose significant risk for chronic kidney disease (26.47% vs 3.33% in controls), making follow-up for stent removal paramount regardless of drainage strategy 7