Characterization and assessment of a novel poly(ethylene oxide)/polyurethane composite hydrogel (Aquavene) as a ureteral stent biomaterial

Comparison of Ureteral Stent Biomaterials: Encrustation Profile in Lithogenic Artificial Urine Models

Ureteral stent encrustation significantly limits indwelling time and can lead to downstream urological problems. However, no ideal polymeric biomaterials have been shown to completely resist encrustation in long-term urine exposure. Recently, 2-hydroxyethyl methacrylate (HEMA)-coated Pellethane was reported as a promising biomaterial resistant to encrustation. This study compared HEMA-coated Pellethane to commercially available stents under two different artificial urine environments. To evaluate the degree and composition of encrustation on HEMA-coated Pellethane, Boston Scientific Tria, Bard InLay Optima, Cook Universa Hydrogel, and Cook Black Silicone stents were used at various dwelling times in two different artificial urine environments. In a batch-flow model, samples of stents were suspended in an artificial urine solution (AUS) at 37 °C. Every 24 h for 11 weeks, 50% of the AUS would be replaced with fresh components using a programmable peristaltic pump system. The stent materials were removed at suitable time intervals and air-dried for 24 h under sterile conditions before follow-up analysis. SEM was used to assess the degree of encrustation, and inductively coupled plasma mass spectrometry (ICP-MS) was employed to quantify the encrusted compositions, specifically for calcium, magnesium, and phosphorus. We measured the weight gain over time due to encrusted deposits on the stents and quantified the amount of Ca, Mg, and P deposited on each encrusted stent. After the 11 week trial, HEMA-coated Pellethane showed the most average mass change. SEM showed that HEMA-coated Pellethane was fully encrusted in just 2 weeks in the AUS environments, and ICP-MS showed that Ca is the most abundant deposit. Among all the tested stents, Black Silicone performed the best. The two AUSs were formulated to encrust more rapidly than physiological conditions. HEMA-coated Pellethane is not an ideal stent material, while silicone is a promising material for advancing ureteral stents.

A modified biodegradable mesh ureteral stent for treating ureteral stricture disease

Ureteral stricture disease (USD) is a common urologic condition. Patients with ureteral stricture disease may suffer from ipsilateral flank pain, nausea, urinary calculi, infection, and impaired renal function. The treatments of USD include surgery, followed by implantation of the ureteral stent to aid the drainage of the urine. The traditional ureteral stent may sometimes cause urological infection, encrustation, and discomfort. To decrease the complication of the ureteral stent, we modified the structure and material based on the traditional ureteral stent. The traditional nondegradable Double-J shape tubular ureteral stent was turned into the biodegradable mesh ureteral stent. The modified mesh ureteral stent and Double-J ureteral stent were inserted into the ureters of the USD animals, respectively. The results of the gross morphology, serology, urinalysis, histology, microstructure, et al. demonstrated that modified mesh ureteral stent has a favorable ability in supporting the ureter and has no effect on cell proliferation, migration, apoptosis, and cell cycle of the human uroepithelial cells. The mesh ureteral stent could relieve ureter obstruction and can be slowly biodegraded after 3-5 months of implantation without the need for a second surgery to remove the stent. Compared to the Double-J ureteral stent, the modified mesh ureteral stent has a lower rate of urinary tract infection and less encrustation. It is expected to be an alternative treatment approach for USD. However, due to the limited number of animals and clinical data, further study focused on the application value in clinical practice are essential. STATEMENT OF SIGNIFICANCE: This study demonstrates: 1. A modified biodegradable mesh ureteral stent; 2. Without the need for a second surgery to remove the stent; 3. A lower rate of urinary tract infection and less encrustation than a double-J ureteral stent; 4. An alternative treatment approach for USD.

Impact of Ureteral Stent Material on Stent-related Symptoms: A Systematic Review of the Literature

Context

Ureteral stents are essential implants that are used on a daily basis. Since their invention, advances in stent design have been directed towards alleviating stent-related symptoms. It remains unclear how the material composition of the stent affects stent-related symptoms.

Objective

To review the literature and define the clinical impact of ureteral stent material on stent-related symptoms.

Evidence acquisition

A literature search of the Embase, MEDLINE (PubMed), and Web of Science databases was conducted on December 17, 2021 to collect articles comparing stent composition materials regarding stent-related symptoms. Thirteen publications met the inclusion criteria, of which only one met the high-quality requirements of the Cochrane Collaboration tool for assessing the risk of bias in randomized trials.

Evidence synthesis

Most trials, including the highest quality trial, seem to support that silicone double-J (DJ) stents reduce stent-related symptoms compared to nonsilicone DJ stents. Regarding physical properties, it seems that "soft" or "flexible" DJ stents reduce stent-related symptoms. However, since there was only one high-quality study with a low risk of bias, it is impossible to draw a definitive conclusion owing to the lack of quality data.

Conclusions

Silicone DJ stents, and by extension "soft" DJ stents, appear to reduce stent-related symptoms compared to nonsilicone polymers and "hard" DJ stents. No definitive conclusion can be drawn owing to a lack of quality evidence. Creating a standard for measuring and reporting physical stent properties should be the first step for further research.

Patient summary

A ureteral stent is a small hollow tube placed inside the ureter to help urine drain from the kidney. We reviewed the literature on the impact of stent material on stent-related symptoms. We found that silicone may reduce stent-related symptoms, but no definitive conclusion can be drawn and further studies are needed.

Characterization and analysis of extended-wear silicone hydrogel contact lenses utilizing novel silicone macromers

Contact lenses are one of the most successful biomaterials in history with a global market estimated to be worth over $17 billion in 2025. Silicone hydrogel contact lenses dominate the market and are complex biphasic biomaterials with several critical material properties needed for clinical use. Careful consideration of composition and chemistry is needed to identify formulations of lenses meeting all commercial standards with the potential for improved manufacturability, cost, and/or next generation use. Four silicone macromers were investigated in this work with varying symmetry of siloxane units and macromer structure, number of siloxane groups, branching, length, and concentration. Novel silicone hydrogel lenses were produced and evaluated for optical transmittance, elastic modulus, oxygen transmissibility, water content, and surface wettability. Several lenses met commercial standards and demonstrated an increase in oxygen permeability (Dk) and inverse relationship with elastic modulus and siloxane concentration, respectively. A hydrophobic/hydrophilic ratio below 1.4 was needed for a co‐continuous water phase. Substitution of methoxypropyl groups for butyl groups increased hydrophobic microdomains leading to decreased optical quality and mechanical properties. Generally, fluorine‐containing silicone macromers allowed for a wider range of successful compositions, and above a certain hydrophilic composition, the presence of trifluoropropyl groups resulted in improved solubility and optically clear lenses. Data also showed asymmetric siloxane macromers have potential to meet critical lens properties at lower overall siloxane content. New lens materials with wider composition ranges meeting all clinical lens properties is a significant challenge and may significantly expand the field.

A new hydrophilic biodegradable ureteral stent restrain encrustation both in vitro and in vivo

Ureteral stents have been widely used as biomedical devices to treat some urological diseases for several decades. However, the encrustation complications hamper the long-time clinical use of the ureteral stents. In this work, a new type of biodegradable material for the ureteral stents, methoxypoly(ethylene glycol)-block-poly(L-lactide-ran-Ɛ-caprolactone) (mPEG-PLACL), is evaluated to overcome this problem. The results show that the hydrophilicity and degradation rate in artificial urine of mPEG-PLACL are both significantly increased. It is worth noting that the mPEG-PLACL shows a lower amount of encrustation after immersing the stents in the dynamic urinary extracorporeal circulation (DUEC) model for 7 days. In addition, 71% Ca and 92% Mg are inhibited in vivo by quantitative analysis. Pathological analysis exhibit that the mPEG-PLACL cause less diffuse mucosal hyperplasia after 7 weeks of implantation. All the results indicate that this new type of biodegradable material had an excellent potential for the ureteral stents in the future.

Ureteral stents in urolithiasis

Ever since the ureteral stent design was fitted with a curl on both sides to prevent it from migrating up or down the ureter some 40 years ago, its use has gained tremendous momentum, aiding in the rise and evolution of endourology and has confidently kept its place in modern time urology. Over the past four decades, several designs, coating and biomaterials have been developed, trying to reduce infection, encrustation and other stent related symptoms. As the ideal stent has not yet been discovered, different ways of helping patients with their complaints have been researched. This review will cover these aspects of stent use in urolithiasis.

Active agents, biomaterials, and technologies to improve biolubrication and strengthen soft tissues

Normal functioning of articulating tissues is required for many physiological processes occurring across length scales from the molecular to whole organism. Lubricating biopolymers are present natively on tissue surfaces at various sites of biological articulation, including eyelid, mouth, and synovial joints. The range of operating conditions at these disparate interfaces yields a variety of tribological mechanisms through which compressive and shear forces are dissipated to protect tissues from material wear and fatigue. This review focuses on recent advances in active agents and biomaterials for therapeutic augmentation of friction, lubrication, and wear in disease and injured states. Various small-molecule, biological, and gene delivery therapies are described, as are tribosupplementation with naturally-occurring and synthetic biolubricants and polymer reinforcements. While reintroduction of a diseased tissue's native lubricant received significant attention in the past, recent discoveries and pre-clinical research are capitalizing on concurrent advances in the molecular sciences and bioengineering fields, with an understanding of the underlying tissue structure and physiology, to afford a desired, and potentially patient-specific, tissue mechanical response for restoration of normal function. Small and large molecule drugs targeting recently elucidated pathways as well as synthetic and hybrid natural/synthetic biomaterials for restoring a desired tissue mechanical response are being investigated for treatment of, for example, keratoconjunctivitis sicca, xeroderma, and osteoarthritis.

Hydroxyapatite-polymer biocomposites for bone regeneration: A review of current trends

Bone tissue engineering has emerged as one of the most indispensable approaches to address bone trauma in the past few decades. This approach offers an efficient and a risk-free alternative to autografts and allografts by employing a combination of biomaterials and cells to promote bone regeneration. Hydroxyapatite (HA) is a ceramic biomaterial that mimics the mineral composition of bones and teeth in vertebrates. HA, commonly produced via several synthetic routes over the years has been found to exhibit good bioactivity, biocompatibility, and osteoconductivity under both in vitro and in vivo conditions. However, the brittle nature of HA restricts its usage for load bearing applications. To address this problem, HA has been used in combination with several polymers in the form of biocomposite implants to primarily improve its mechanical properties and also enhance the implants' overall performance by simultaneously exploiting the positive effects of both HA and the polymer involved in making the biocomposite. This review article summarizes the past and recent developments in the evolution of HA-polymer biocomposite implants as an "ideal" biomaterial scaffold for bone regeneration. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2046-2057, 2018.

Ureteral double-J stents performances toward encrustation after long-term indwelling in a dynamic in vitro model

Three different single-lumen double-J ureteral stents of different materials were studied and compared after the insertion into a dynamic in vitro model with sterile artificial urine up to 6 months. The aim was to evaluate, at selected time steps of 1, 3, and 6 months, the material performances of the stents in preventing the formation of inorganic encrustations. Morphological, compositional, and qualitative analyses were carried out both before stent insertion and after stent permanence for the different time steps, showing an increasing level of encrustation which remains particularly low in the case of two polyurethane stents. Mechanical tests show that both the polyurethane stents and the chitosan one do not decrease the tensile strength after 6 months of indwelling. Evaluation of the wetting behavior of the stent outer surfaces indicates a hydrophilic behavior in most of the cases, which is generally preserved after immersion in artificial urine for the different time steps. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2244-2253, 2017.

Plasma-induced surface modification of polydimethylsiloxane aimed at reducing salt and protein deposition

Polydimethylsiloxane (PDMS) is an elastomer that is widely used in construction and for biological and biomedical applications. The biocompatibility of PDMS was improved by different surface treatment methods, i.e., plasma treatment or a combination of plasma treatment with UV-irradiation or redox initiator, to minimize the effects of deposition of salts and proteins. In this work we used the vinyl monomers sulfobetaine and AMPS which have good biocompatible properties.

New developments in ureteral stent design, materials and coatings

Ureteral stents are used in a variety of urological diseases and procedures. The majority of patients with indwelling ureteral stents experience bothersome symptoms and are at increased risk for urinary tract infection. Stent encrustation and the associated complications can also result in significant patient morbidity. The development of new stent designs using novel biomaterials, stent coatings and drug-eluting technologies are being applied to reduce the disadvantageous features of ureteral stents.

Endourological management of forgotten encrusted ureteral stents

PURPOSE

To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation.

MATERIALS AND METHODS

From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function.

RESULTS

In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases.

CONCLUSION

Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

Physicochemical characterisation and biological evaluation of polyvinylpyrrolidone-iodine engineered polyurethane (Tecoflex(®))

Bacterial adhesion and encrustation are the known causes for obstruction or blockage of urethral catheters and ureteral stents, which often hinders their effective use within the urinary tract. In this in vitro study, polyvinylpyrrolidone-iodine (PVP-I) complex modified polyurethane (Tecoflex(®)) systems were created by physically entrapping the modifying species during the reversible swelling of the polymer surface region. The presence of the PVP-I molecules on this surfaces were verified by ATR-FTIR, AFM and SEM-EDAX analysis, while wettability of the films was investigated by water contact angle measurements. The modified surfaces were investigated for its suitability as a urinary tract biomaterial by comparing its lubricity and ability to resist bacterial adherence and encrustation with that of base polyurethane. The PVP-I modified polyurethane showed a nanopatterned surface topography and was highly hydrophilic and more lubricious than control polyurethane. Adherence of both the gram positive Staphylococcus aureus (by 86%; **P < 0.01) and gram-negative Pseudomonas aeruginosa (by 80%; *P < 0.05) was significantly reduced on the modified surfaces. The deposition of struvite and hydroxyapatite the major components of urinary tract encrustations were significantly less on PVP-I modified polyurethane as compared to base polyurethane, especially reduction in hydroxyapatite encrustation was particularly marked. These results demonstrated that the PVP-I entrapment process can be applied on polyurethane in order to reduce/lower complications associated with bacterial adhesion and deposition of encrustation on polyurethanes.

Polymers as ureteral stents

Ureteral stents find wide application in urology. The majority of patients with indwelling ureteral stents are at an increased risk of urinary tract infection. Stent encrustation and its associated complications lead to significant morbidity. This review critically evaluates various polymers that find their application as ureteral stents with regard to various issues such as encrustation, bacterial colonization, urinary tract infections, and related clinical issues. A complete literature survey was performed, and all the relevant articles were scrutinized thoroughly. We discuss issues of encrustation/biofilm formation, new approaches to their testing, polymers currently available for use, new biomaterials, coatings, and novel ureteral stent designs, thereby providing a complete update on recent advances in the development of stents. Finally, we discuss the future of biomaterial use in the urinary tract.

Hydrogels for tissue engineering and delivery of tissue-inducing substances

This manuscript presents hydrogels (HGs) from a tissue engineering perspective being especially written for those who are approaching this field by offering a concise but inclusive review of hydrogel synthesis, properties, characterization methods, and applications.

Structure and Drug Release in a Crosslinked Poly(Ethylene Oxide) Hydrogel

Hydrogels are a continuously expanding class of pharmaceutical polymers designed for sustained or controlled drug release. The structure and intermolecular interactions in such systems define their macroscopic properties. The aim of this study was to investigate the mechanism of swelling, drug impregnation, and drug release from poly(ethylene oxide) (PEO) gel crosslinked by urethane bonds. A combination of SAXS/WAXS/SANS techniques enabled us to determine the phase transition between lamellar and extended gel network, and to apply different descriptions of crystallinity, based on lamellar and crystal lattice structures. It is shown that even low (1-7% w/w) loading of model drugs acetaminophen and caffeine, produced significant disorder in the polymer matrix. This effect was particularly pronounced for acetaminophen due to its specific ability to form complexes with PEO. The drug-release profiles were analyzed using a general cubic equation, proposed for this work, which allowed us to determine the gel hydration velocity. The results indicate that the release profiles correlate inversely with the polymer crystallinity.

Technology insight: Novel ureteral stent materials and designs

Ureteral stents are an important tool for aiding upper urinary tract drainage, but can cause significant patient morbidity. Common problems include stent-induced pain, hematuria, dysuria, infection, and encrustation. From a urologist's perspective, stents must be easy to maneuver in the urinary tract, radiopaque, and affordable. Since the development of the modern day stent in 1978, stents have evolved to include softer biomaterials that are more resistant to encrustation and infection. An ideal biomaterial is one that is not affected by its environment and does not elicit reactive changes in surrounding tissues. To date, the ideal biomaterial or stent does not exist. This review discusses developments that address the issues of infection, biofilm formation, encrustation, and patient comfort. Stent materials including polyurethane, silicone, biodegradable substances and new combination polymers are reviewed, in addition to novel stent coatings such as heparin, hydrogel, and silver nitrate. Ureteral stent technologies currently lag behind vascular stents, particularly drug-eluting stents, but new developments will continue to improve these essential urological tools.

Use of polyurethane with sustained release dexamethasone in delayed adjustable strabismus surgery

AIM

To determine the effect of polyurethane film with sustained release dexamethasone (SRD) in delayed adjustable strabismus surgery.

METHODS

A prospective, masked observer, controlled study was performed in rabbits. Thirty four rabbit eyes were divided into three groups. After recession of the superior rectus muscle (SRM), polyurethane film with or without SRD, or balanced salt solution was applied beneath and over SRM in the polyurethane-dexamethasone group (group P-D), polyurethane group (group P), and the control group (group C), respectively. Delayed adjustment was performed once on each SRM at 4 and 6 weeks postoperatively by a masked observer. The possible length to adjust and the necessary force required for the adjustment, as well as the degree of any adhesions, were also evaluated.

RESULTS

In the control group, adjustment was impossible in all of the eyes at 4 and 6 weeks postoperatively. In group P-D, adjustment was possible in 11 out of 11 eyes (11/11) 4 weeks postoperatively and in 10/11 eyes 6 weeks postoperatively. In group P, adjustment was possible in 9/11 eyes 4 weeks postoperatively and in 10/12 eyes 6 weeks postoperatively.

CONCLUSIONS

Use of polyurethane film with and without SRD could delay adjustment in most eyes for up to 6 weeks postoperatively. Polyurethane is helpful for delaying adjustment in rabbit eyes until 6 weeks postoperatively without the need for frequent topical instillation of steroids.

Second Prize: Double-Blind Randomized Controlled Trial Assessing the Safety and Efficacy of Intravesical Agents for Ureteral Stent Symptoms after Extracorporeal Shockwave Lithotripsy

BACKGROUND AND PURPOSE

Ureteral stents are a significant source of pain and discomfort for many urologic patients. A novel approach to addressing this problem is the intravesical instillation of a selected pharmacologic agent after stent insertion. The purpose of this study was to assess the safety and efficacy of intravesical instillation of various agents in reducing ureteral stent-associated discomfort in patients requiring a stent after extracorporeal shockwave lithotripsy (SWL).

PATIENTS AND METHODS

In this double-blind prospective trial, 42 patients were randomized to receive intravesical instillation of one of three agents (oxybutynin, alkalinized lidocaine, or ketorolac) or a control solution (0.9% sodium chloride) immediately after stent insertion at time of SWL. The four groups of patients were demographically similar. Preoperative, intraoperative, and postoperative data were collected prospectively and analyzed statistically. The primary outcome measure was reduction in ureteral stent symptoms, and the secondary outcome measure was the safety of intravesical instillation of each agent through assessment of drug-related adverse events.

RESULTS

There were no intraoperative or postoperative complications, nor were there any serious side effects attributable to any of the intravesically instilled agents. There was a statistically significant decrease in stent-related discomfort at the 1-hour time point in the group of patients who received intravesical ketorolac compared with the control group.

CONCLUSIONS

Intravesical instillation represents a novel approach to the problem of ureteral stent-related discomfort. From our results, ketorolac appears to be the most effective intravesical agent in reducing stent-related patient discomfort, and we have established that intravesical instillation of ketorolac is safe in humans.

Microscopic techniques as potential tools to quantify the extent of bioadhesion of liquid systems

This work demonstrates the potential of fluorescence and confocal microscopy as techniques to quantify both the extent and duration of bioadhesion of alginate solutions to porcine oesophageal tissue using an in vitro model. The retention of low (40 kDa), medium (240 kDa) and high (416 kDa) MW alginates was quantified via three methods of analysis. Fluorimetric analysis of the dose removed from the oesophageal surface suggested that the percentage of the original dose retained at 30 min was 7.9 +/- 7.0%, 21.9 +/- 9.5% and 23.7 +/- 5.8% for the alginates in order of increasing MW. Analysis of the dose adhered at 30 min using fluorescence microscopy demonstrated that 5.5 +/- 1.9%, 7.1 +/- 2.7% and 18.2 +/- 1.7% of the original dose of the alginate solutions was retained at 30 min. The results found using confocal microscopy showed that the percentage of the original dose adhered at 30 min of the low, medium and high MW alginates were 4.5 +/- 1.9%, 7.2 +/- 5.3% and 11.8 +/- 4.3%, respectively. All techniques demonstrated significantly greater retention of the high MW solution at 30 min compared to the low MW solution. Both confocal and fluorescence microscopy may be used as techniques to evaluate the bioadhesion of liquid systems.

Influence of surface morphology and chemistry on the enzyme catalyzed biodegradation of polycarbonate-urethanes

Polycarbonate based polyurethanes were synthesized with varying hard segment content as well as hard segment chemistry based on three different diisocyanates,1,6-hexane diisocyanate (HDI), 4.4'-methylene bisphenyl diisocyanate (MDI) and 4,4-methylene biscyclohexyl diisocyanate (HMDI). The surface chemistry and morphology were characterized using X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM). The polymers were incubated with cholesterol esterase (CE) in a phosphate buffer solution at 37 degrees C over 10 weeks. XPS results showed that the surface chemistry changed as the size and chemistry of the hard segment varied within the materials. AFM images exhibited distinctive surface morphologies for all polymers, and this was particularly apparent with changes in the hard segment chemistry. The results showed that the surface of HDI polymers consisted of relatively stiff rod-like structures, which corresponded to the soft segment domains. Polymers with a higher HDI content exhibited a dense top layer containing a relatively higher hard segment component, covering the sub-surface matrix of rod like structures. The MDI based polyurethane had large aggregates on its top surface, which corresponded to the aggregation of harder components. The HMDI based polycarbonate-urethane presented a relatively homogeneous surface where no phase separation could be detected. The relative differences in hard and soft segment content in their surface structure was supported by XPS findings. The analysis of the biodegradation results, concluded that enzyme catalyzed biodegradation within these materials was initiated in amorphous soft segment regions located in the region of the interface between hard and soft segments. A higher hard segment content at the surface contributed significantly to an increase in biostability. The findings provided an enhanced understanding for the role of surface molecular structure in the enzyme catalyzed biodegradation of polyurethanes.

Poly(epsilon-caprolactone) and poly(epsilon-caprolactone)-polyvinylpyrrolidone-iodine blends as ureteral biomaterials: characterisation of mechanical and surface properties, degradation and resistance to encrustation in vitro

This study describes the physicochemical properties and in vitro resistance to encrustation of solvent cast films composed of either poly(epsilon-caprolactone) (PCL), prepared using different ratios of high (50,000) to low (4000) (molecular weight) m.wt., or blends of PCL and the polymeric antimicrobial complex, poly(vinylpyrrolidone)-iodine (PVP-I). The incorporation of PVP-I offered antimicrobial activity to the biomaterials. Films were characterised in terms of mechanical (tensile analysis, dynamic mechanical thermal analysis) and surface properties (dynamic contact angle analysis, scanning electron microscopy), whereas degradation (at 37 degrees C in PBS at pH 7.4) was determined gravimetrically. The resistance of the films to encrustation was evaluated using an in vitro encrustation model. Reductions in the ratio of high:low-m.wt. PCL significantly reduced the ultimate tensile strength, % elongation at break and the advancing contact angle of the films. These effects were attributed to alterations in the amorphous content and the more hydrophilic nature of the films. Conversely, there were no alterations in Young's modulus, the viscoelastic properties and glass-transition temperature. Incorporation of PVP-I did not affect the mechanical or rheological properties of the films, indicative of a limited interaction between the two polymers in the solid state. Manipulation of the high:low m.wt. ratio of PCL significantly altered the degradation of the films, most notably following longer immersion periods, and resistance to encrustation. Accordingly, maximum degradation and resistance to encrustation was observed with the biomaterial composed of 40:60 high:low m.wt. ratios of PCL; however, the mechanical properties of this system were considered inappropriate for clinical application. Films composed of either 50:50 or 60:40 ratio of high:low m.wt. PCL offered an appropriate compromise between physicochemical properties and resistance to encrustation. This study has highlighted the important usefulness of degradable polymer systems as ureteral biomaterials.

Evaluation of a poly(vinyl pyrollidone)-coated biomaterial for urological use

The associated problems of bacterial biofilm formation and encrustation that may cause obstruction or blockage of urethral catheters and ureteral stents often hinders the effective use of biomaterials within the urinary tract. In this in vitro study, we have investigated the surface properties of a hydrophilic poly(vinyl pyrollidone) (PVP)-coating applied to polyurethane and determined its suitability for use as a urinary tract biomaterial by comparing its lubricity and ability to resist bacterial adherence and encrustation with that of uncoated polyurethane and silicone. The PVP-coated polyurethane was significantly more hydrophilic and more lubricious than either uncoated polyurethane or silicone. Adherence of a hydrophilic Escherichia coli isolate to PVP-coated polyurethane and uncoated polyurethane was similar but significantly less than adherence to silicone. Adherence of a hydrophobic Enterococcus faecalis isolate to PVP-coated polyurethane and silicone was similar but was significantly less than adherence to uncoated polyurethane. Struvite encrustation was similar on the PVP-coated polyurethane and silicone but significantly less than on uncoated polyurethane. Furthermore, hydroxyapatite encrustation was significantly less on the PVP-coated polyurethane than on either uncoated polyurethane or silicone. The results suggest that the PVP-coating could be useful in preventing complications caused by bacterial biofilm formation and the deposition of encrustation on biomaterials implanted in the urinary tract and, therefore, warrants further evaluation.

Assessment of PEO/PTMO multiblock copolymer/segmented polyurethane blends as coating materials for urinary catheters: in vitro bacterial adhesion and encrustation behavior

The effective long-term use of indwelling urinary catheters has often been hindered by catheter-associated infection and encrustation. In this study, the suitability of poly(ethylene oxide) (PEO)-based multiblock copolymer/segmented polyurethane (SPU) blends as coating materials for the commercial urinary catheters was assessed by measuring swellability, bacterial adhesion, and encrustation behavior. When exposed to PBS (pH 7.4), the blends absorbed a significant amount of water, which was proportional to the copolymer content. It was demonstrated from bacterial adhesion tests that compared to bare SPU, the blend surfaces could significantly reduce the adhesion of E. coli, P. mirabilis, and S. epidermidis; the number of adherent bacteria correlated with the amount of copolymer additive. indicating that the swellability of the blends affected bacterial adhesion. Of the bacteria studied, the greatest effect of the copolymer additive was observed in S. epidermidis adhesion, in which there was an 85% decrease compared to bare SPU with a small amount of copolymer additive as low as 5% based on a dried blend. By using an artificial bladder model, allowing the catheter to be blocked by encrustation, it was revealed that the blend surfaces could effectively resist encrustation. The duration of patency was extended up to 20 +/- 3.1 h on the blend surface containing 10% of the copolymer additive, whereas the silicone-coated catheter, a control, required the least time for blockage, 7.8 +/- 3.1 h. The superior characteristics of the blends compared to other surfaces might be attributed to their PEO-rich surfaces, produced by the migration of PEO phase in the copolymer chain of the blends in an aqueous environment, and provide promising potential as a coating material on the urinary catheter for long-term catheterization.

PDMS-based polyurethanes with MPEG grafts: mechanical properties, bacterial repellency, and release behavior of rifampicin

PDMS-based polyurethanes (PUs) grafted with monomethoxy poly(ethylene glycol) (MPEG) were synthesized to develop a coating material for urinary catheters with a silicone surface for minimizing urinary tract infections. MPEG was grafted on PDMS-based PUs by two methods depending on the PU synthetic routes: esterification and allophanate reactions. It was confirmed from mechanical characterization that an increase of the hard segment amount enhanced the ultimate strength and Young's modulus, while reducing elongation at the end-points. The incorporation of MPEG in PDMS-based PUs induced a decrease in tensile strength and Young's modulus, and increased elongation at the break point due to its high flexibility. When hydrated in distilled water, mechanical properties of all PUs synthesized in this study deteriorated due to water absorption. It was evident from the bacterial adhesion test that PDMS-based PUs showed moderate resistance to adhesion of E. coli on their surfaces compared to Pellethane, while the incorporation of MPEG significantly enhanced repellency to bacteria, including E. coli and S. epidermidis. We also studied the release behavior of an antibiotic drug, rifampicin, from the polymeric devices fabricated by solvent evaporation. Although rifampicin is hydrophilic and soluble in pH 7.4 phosphate buffer, it showed a sustained release over 45 days from PDMS-based PUs with MPEG that were grafted on ethylene glycol residues by allophanate reaction. This release characteristic was predominantly influenced by a hydrogen bond interaction between the polymers and rifampicin, which was confirmed through an ATR-IR study. This may imply that the specific interaction is responsible for the delayed release. Considering the mechanical properties, morphologies of drug-incorporated polymeric matrices, and drug release behaviors, PDMS-based PU with MPEG that were grafted on ethylene glycol (a chain extender) residues by allophanate reaction showed better material properties for uretharal catheter coating pusposes in order to minimize urinary tract infections.

Encrustation of biomaterials in the urinary tract

The present review focuses on technological advances and relevant research related to encrustation of biomaterials in the urinary tract. The importance of physical and chemical biomaterial type, biocompatibility, material coatings such as hydrogels, and infection related to alloplastic materials used in urological practice are discussed. Recent in-vitro and in-vivo research has focused on materials that will reduce encrustation and bacterial biofilm formation, complications that limit the long-term use of urinary materials. Coordinating scientific resources in a multidisciplinary manner for a better understanding of factors that are involved in encrustation and biofilm formation will offer the potential to modify or resolve the problem of encrustation of foreign materials in the urinary tract.

Morphology of and release behavior from porous polyurethane microspheres

A novel biomaterial application of porous microspheres is for sustained delivery of biologically active agents. Recent studies have pointed out the importance of biomaterial porosity in promoting biocompatibility and controlling release rate of active agents. The objective of this research was to investigate the effect of chain-extending agent on the porosity and release behavior of polyurethane (PU) microspheres prepared using a two-step suspension polycondensation method with methylene diphenyl diisocyanate (MDI) as the isocyanate, polyethylene glycol (PEG400) as the diol, and 1,4-butanediol as the chain-extending agent. Chain-extending agent was used to increase the ratio of hard to soft segments of the PU network, and its effect on microsphere morphology was studied with scanning electron microscopy. According to the results, porosity was significantly affected by the amount of chain-extending agent. The pore size decreased as the concentration of chain-extending agent increased from zero to 50 mole%. With further increase of chain-extending agent to 60 and 67%, PU chains became stiffer and formation of pores was inhibited. Therefore, pore morphology was significantly affected by variations in the amount of chain-extending agent. The release behavior of microspheres was investigated with diazinon as the active agent. After an initial burst, corresponding to 3% of the incorporated amount of active agent, the release rate was zero order.