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Massouh Skorin R, Mahfouz A, Escovar la Riva P. Systematic review on active treatment for urinary fistula after partial nephrectomy. Actas Urol Esp 2022; 46:387-396. [PMID: 35780049 DOI: 10.1016/j.acuroe.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Urinary fistula is expected to become more frequent in urological practice as a result of expanding indication of partial nephrectomy given it's oncological results equivalent to those of radical nephrectomy but at a lower risk of progression to chronic kidney disease, lower cardiovascular morbidity, and overall mortality. OBJECTIVES Review and compare different techniques of contemporary active management for urinary fistula after partial nephrectomy. METHODS A systematic literature search on the MEDLINE database was conducted in March 2020, combining the terms: "urine leak", "urine leakage", "urinary leak" and "urinary fistula", with: "partial nephrectomy", "nephron sparing surgery" and "renal sparing surgery". This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only articles related to active treatment were eligible. Abstracts in English and Spanish from the last two decades were screened. No restriction based on study design nor the length of follow-up. PRIMARY OUTCOMES 1) Leak resolution rate 2) Time course of leak resolution and 3) Number of interventions needed for resolution. RESULTS Multiple studies were found. There were no randomized controlled trials. Urinary fistula can be solved in many ways with active treatment, with a high success rate (97.5%), an average of 1.4 intervention-per-patients and a mean time for leak resolution of 11 days (median of 3 days). CONCLUSION There is a high risk of bias due to the study's methodology. There is a broad range of effective alternatives and various approaches to solve urinary fistula in an appropriate timing.
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Affiliation(s)
| | - A Mahfouz
- Hospital Clinico San Borja Arriaran, Santiago, Chile
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2
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Jones JM, Gannett C, Jones M, Winata E, Zhu M, Buckley L, Lazar J, Hedges JC, McCarthy SJ, Xie H. Development of a Hemostatic Urinary Catheter for Transurethral Prostatic Surgical Applications. Urology 2022; 165:359-365. [PMID: 35461919 PMCID: PMC10860670 DOI: 10.1016/j.urology.2022.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate a novel transurethral hemostatic catheter device with an integrated chitosan endoluminal hemostatic dressing (CEHD). Development and implementation of this technology may help address bleeding following surgery such as transurethral resection of prostate (TURP). Bleeding remains the most common complication following TURP, leading to increased morbidity and hospitalization. METHODS Investigation of hemostasis, delivery, safety and efficacy of the CEHD device is conducted using Female Yorkshire swine (N = 23). Hemostatic efficacy of the CEHD (N = 12) is investigated against a control of gauze (N = 12) in a splenic injury model (3 swine). The delivery, safety, and efficacy of the CEHD device (N = 10) are investigated against Foley-catheter control (N = 10) for 7 days using a swine bladder-neck-injury model. RESULTS In the splenic injury study, 9/12 CEHD dressings successfully achieved hemostasis within 150 seconds (mean 83 seconds) vs success of 6/12 (mean 150 seconds) for gauze (P = .04). In the 7-day study, the CEHD was successfully deployed in 10/10 animals and all dressings were tolerated without histologic or clinical adverse effect. Hemostasis of the CEHD device was found to be noninferior to control catheters. Noninferiority is attributed to low bleeding rates in the swine bladder neck injury model. CONCLUSION This investigation successfully demonstrated the feasibility of transurethral deployment of the CEHD in vivo. Routine use of safe and slowly dissolvable CEHDs could reduce the rate of complications and hospitalizations associated with bleeding and blood loss in TURP procedures. Further investigation is warranted.
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Affiliation(s)
- James M Jones
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | | | | | | | - Meihua Zhu
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Lisa Buckley
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Jack Lazar
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Jason C Hedges
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR; Department of Urology, Oregon Health & Science University, Portland, OR
| | | | - Hua Xie
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR; Department of Surgery, Oregon Health & Science University, Portland, OR.
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3
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Revisión sistemática del tratamiento activo de la fístula urinaria después de la nefrectomía parcial. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bhave G, Chen JC, Singer A, Sharma A, Robinson JT. Distributed sensor and actuator networks for closed-loop bioelectronic medicine. MATERIALS TODAY (KIDLINGTON, ENGLAND) 2021; 46:125-135. [PMID: 34366697 PMCID: PMC8336425 DOI: 10.1016/j.mattod.2020.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Designing implantable bioelectronic systems that continuously monitor physiological functions and simultaneously provide personalized therapeutic solutions for patients remains a persistent challenge across many applications ranging from neural systems to bioelectronic organs. Closed-loop systems typically consist of three functional blocks, namely, sensors, signal processors and actuators. An effective system, that can provide the necessary therapeutics, tailored to individual physiological factors requires a distributed network of sensors and actuators. While significant progress has been made, closed-loop systems still face many challenges before they can truly be considered as long-term solutions for many diseases. In this review, we consider three important criteria where materials play a critical role to enable implantable closed-loop systems: Specificity, Biocompatibility and Connectivity. We look at the progress made in each of these fields with respect to a specific application and outline the challenges in creating bioelectronic technologies for the future.
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Pacheco M, Barros AA, Aroso IM, Autorino R, Lima E, Silva JM, Reis RL. Use of hemostatic agents for surgical bleeding in laparoscopic partial nephrectomy: Biomaterials perspective. J Biomed Mater Res B Appl Biomater 2020; 108:3099-3123. [PMID: 32458570 DOI: 10.1002/jbm.b.34637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
Abstract
In recent years, there was an abrupt increase in the incidence of renal tumors, which prompt up the appearance of cutting-edge technology, including minimally invasive and organ-preserving approaches, such as laparoscopic partial nephrectomy (LPN). LPN is an innovative technique used to treat small renal masses that have been gaining popularity in the last few decades due to its promissory results. However, the bleeding control remains the main challenge since the majority of currently available hemostatic agents (HAs) used in other surgical specialities are inefficient in LPN. This hurried the search for effective HAs adapted for LPN surgical peculiarities, which resulted on the emergence of different types of topical HAs. The most promising are the natural origin HAs because of their inherent biodegradability, biocompatibility, and lowest toxicity. These properties turn them top interests' candidates as HAs in LPN. In this review, we present a deep overview on the progress achieved in the design of HAs based on natural origin polymers, highlighting their distinguishable characteristics and providing a clear understanding of their hemostat's role in LPN. This way it may be possible to establish a structure-composition properties relation, so that novel HAs for LPN can be designed to explore current unmet medical needs.
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Affiliation(s)
- Margarida Pacheco
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexandre A Barros
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ivo M Aroso
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Estêvão Lima
- School of Health Sciences, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,Surgical Sciences Research Domain, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Joana M Silva
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Gao L, Ma S, Luo J, Bao G, Wu Y, Zhou F, Liang Y. Synthesizing Functional Biomacromolecular Wet Adhesives with Typical Gel–Sol Transition and Shear-Thinning Features. ACS Biomater Sci Eng 2019; 5:4293-4301. [DOI: 10.1021/acsbiomaterials.9b00939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Luyao Gao
- State Key Laboratory of Applied Organic Chemistry, Lanzhou University, Lanzhou 730000, P. R. China
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, 18 Middle Tianshui Road, Lanzhou 730000, P. R. China
| | - Shuanhong Ma
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, 18 Middle Tianshui Road, Lanzhou 730000, P. R. China
| | - Jiajun Luo
- Division of Surgery & Interventional Science, Institute of Orthopaedic & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore HA7 4LP, United Kingdom
| | - Guangjie Bao
- College of Dentistry, Northwest Minzu University, 1 New Northwest Villiage, Lanzhou 730030, P. R. China
| | - Yang Wu
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, 18 Middle Tianshui Road, Lanzhou 730000, P. R. China
| | - Feng Zhou
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, 18 Middle Tianshui Road, Lanzhou 730000, P. R. China
| | - Yongmin Liang
- State Key Laboratory of Applied Organic Chemistry, Lanzhou University, Lanzhou 730000, P. R. China
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Wu H, Williams GR, Wu J, Wu J, Niu S, Li H, Wang H, Zhu L. Regenerated chitin fibers reinforced with bacterial cellulose nanocrystals as suture biomaterials. Carbohydr Polym 2018; 180:304-313. [DOI: 10.1016/j.carbpol.2017.10.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/15/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
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8
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Yang S, Dong Q, Yang H, Liu X, Gu S, Zhou Y, Xu W. N-carboxyethyl chitosan fibers prepared as potential use in tissue engineering. Int J Biol Macromol 2015; 82:1018-22. [PMID: 26522245 DOI: 10.1016/j.ijbiomac.2015.10.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 10/21/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022]
Abstract
To improve the hydrophilicity of chitosan fiber, N-carboxyethyl chitosan fiber was prepared through Michael addition between chitosan fiber with acrylic acid. The structure was studied by (1)H NMR. The degree of N-substitution, measured via (1)H NMR, was easily varied from 0.10 to 0.51 by varying the molar ratio of acrylic acid to chitosan. Series of properties of N-carboxyethyl chitosan fiber including mechanical property, crystallinity, thermal property and in vitro degradation were investigated by Instron machine, X-ray diffraction and differential scanning calorimetry and thermogravimetric analysis, respectively. The results showed that, introducing the carboxyethyl group into the backbone chain of chitosan fiber destroyed the intra/intermolecular hydrogen bonding, leading to loss of the intra/intermolecular hydrogen bonding and improvement of hydrophilicity. Indirect cytotoxicity assessment of carboxyethyl chitosan fibers was investigated using a L929 cell line. And the obtained results clearly suggested that N-carboxyethyl chitosan fiber was nontoxic to L929 cells. The N-carboxyethyl chitosan fibers are potential as tissue engineering scaffolds.
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Affiliation(s)
- Shuoshuo Yang
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, People's Republic of China; Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, People's Republic of China
| | - Qi Dong
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, People's Republic of China; Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, People's Republic of China
| | - Hongjun Yang
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, People's Republic of China; Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, People's Republic of China
| | - Xin Liu
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, People's Republic of China; Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, People's Republic of China
| | - Shaojin Gu
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, People's Republic of China; Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, People's Republic of China
| | - Yingshan Zhou
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, People's Republic of China; Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, People's Republic of China.
| | - Weilin Xu
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, People's Republic of China; Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, People's Republic of China
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9
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Yan W, Shen L, Ji Y, Yang Q, Shen X. Chitin nanocrystal reinforced wet-spun chitosan fibers. J Appl Polym Sci 2014. [DOI: 10.1002/app.40852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Weixia Yan
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials; College of Material Science and Engineering, Donghua University; Shanghai 201620 China
- Analysis and Testing Center; Donghua University; Shanghai 201620 China
| | - Libin Shen
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials; College of Material Science and Engineering, Donghua University; Shanghai 201620 China
| | - Yali Ji
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials; College of Material Science and Engineering, Donghua University; Shanghai 201620 China
| | - Qing Yang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials; College of Material Science and Engineering, Donghua University; Shanghai 201620 China
| | - Xinyuan Shen
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials; College of Material Science and Engineering, Donghua University; Shanghai 201620 China
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Xie H, Lucchesi L, Teach JS, Virmani R. Long-term outcomes of a chitosan hemostatic dressing in laparoscopic partial nephrectomy. J Biomed Mater Res B Appl Biomater 2011; 100:432-6. [DOI: 10.1002/jbm.b.31966] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 08/15/2011] [Accepted: 09/05/2011] [Indexed: 11/10/2022]
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11
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Gu R, Sun W, Zhou H, Wu Z, Meng Z, Zhu X, Tang Q, Dong J, Dou G. The performance of a fly-larva shell-derived chitosan sponge as an absorbable surgical hemostatic agent. Biomaterials 2010; 31:1270-7. [DOI: 10.1016/j.biomaterials.2009.10.023] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 10/09/2009] [Indexed: 11/26/2022]
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12
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13
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Kenneth Ward W. A review of the foreign-body response to subcutaneously-implanted devices: the role of macrophages and cytokines in biofouling and fibrosis. J Diabetes Sci Technol 2008; 2:768-77. [PMID: 19885259 PMCID: PMC2769792 DOI: 10.1177/193229680800200504] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The biological response to implanted biomaterials in mammals is a complex series of events that involves many biochemical pathways. Shortly after implantation, fibrinogen and other proteins bind to the device surface, a process known as biofouling. Macrophages then bind to receptors on the proteins, join into multinucleated giant cells, and release transforming growth factor beta and other inflammatory cytokines. In response to these signals, quiescent fibroblasts are transformed into myofibroblasts, which synthesize procollagen via activation of Smad mediators. The procollagen becomes crosslinked after secretion into the extracellular space. Mature crosslinked collagen and other extracellular matrix proteins gradually contribute to formation of a hypocellular dense fibrous capsule that becomes impermeable or hypopermeable to many compounds. Porous substrates and angiogenic growth factors can stimulate formation of microvessels, which to some extent can maintain analyte delivery to implanted sensors. However, stimulation by vascular endothelial growth factor alone may lead to formation of leaky, thin-walled, immature vessels. Other growth factors are most probably needed to act upon these immature structures to create more robust vessels.During implantation of foreign bodies, the foreign-body response is difficult to overcome, and thousands of biomaterials have been tested. Biomimicry (i.e., creating membranes whose chemical structure mimics natural cellular compounds) may diminish the response, but as of this writing, it has not been possible to create a stealth material that circumvents the ability of the mammalian surveillance systems to distinguish foreign from self.
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Affiliation(s)
- W Kenneth Ward
- Legacy Clinical Research and Technology Center and Oregon Health and Science University, Portland, Oregon, USA.
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