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Wen KC, Li ZA, Liu JH, Zhang C, Zhang F, Li FQ. Recent developments in ureteral stent: Substrate material, coating polymer and technology, therapeutic function. Colloids Surf B Biointerfaces 2024; 238:113916. [PMID: 38636438 DOI: 10.1016/j.colsurfb.2024.113916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
The ureteral stent is an effective treatment for clinical ureteral stricture following urological surgery, and the functional coating of the stent could effectively inhibit bacterial colonization and other complications. The present review provides an analysis and description of the materials used in ureteral stents and their coatings. Emphasis is placed on the technological advancements of functional coatings, taking into consideration the characteristics of these materials and the properties of their active substances. Furthermore, recent advances in enhancing the therapeutic efficacy of functional coatings are also reviewed. It is anticipated that this article will serve as a valuable reference providing insights for future research development on new drug-loaded ureteral stents.
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Affiliation(s)
- Kai-Chao Wen
- School of Medicine, Shanghai University, Shanghai 200444, China; Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China
| | - Zheng-An Li
- School of Medicine, Shanghai University, Shanghai 200444, China; Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China
| | - Ji-Heng Liu
- Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China
| | - Chuan Zhang
- School of Medicine, Shanghai University, Shanghai 200444, China.
| | - Feng Zhang
- Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China.
| | - Feng-Qian Li
- School of Medicine, Shanghai University, Shanghai 200444, China; Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China.
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Putrantyo II, Warli SM, Siregar GP, Prapiska FF, Kadar DD, Sihombing B. Role of ureteral stent material and coating to prevent ureteral stent related issue: A systematic review and meta analysis. Arch Ital Urol Androl 2024; 96:12067. [PMID: 38441193 DOI: 10.4081/aiua.2024.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Ureteral stents require materials that balance bulk and surface properties. Achieving both can be challenging, as ideal bulk properties may not align with optimal surface properties. Thus, researching coatings and biomanufacturing methods for ideal materials is essential. METHODS A systematic review and meta-analysis, following PRISMA Guidelines, involved literature searches across five databases: PubMed, Scopus, Embase, ClinicalKey, and Cochrane. From 417 screened articles, eight studies were deemed eligible for qualitative and quantitative analysis. The selected articles underwent bias assessment using ROB Tools 2. RESULTS The systematic review analyzed 1.356 participants. Findings revealed that firm ureteral stents significantly increased risk of infection, hematuria, and lower body pain. On the contrary, soft stents reduced infection (OR: 0.62; p=0.004), hematuria (OR: 0.60; p<0.001), and lower body pain (OR: 0.63; p=0.0002). However, infection reduction effect was uncertain due to heterogeneity. Coated vs non-coated material analysis found no difference in encrustation (OR: 1.26; p=0.52) or infection (OR: 1.67; p=0.99). Stent firmness did not affect encrustation on double J stent (OR: 0.97; p=0.17). CONCLUSIONS Softer materials like silicone are preferred for ureteral stents to reduce symptoms like hematuria and lower body pain. Coatings like silver nanoparticles and triclosan, while enhancing antimicrobial properties, did not effectively lower infection risk.
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Affiliation(s)
- Ignatius Ivan Putrantyo
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Depok; Haji Adam Malik General Hospital, Medan.
| | - Syah Mirsya Warli
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medan; Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan.
| | - Ginanda Putra Siregar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medan.
| | - Fauriski Febrian Prapiska
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medan.
| | - Dhirajaya Dharma Kadar
- Division of Urology, Department of Surgery, FacultDivision of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medany of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital.
| | - Bungaran Sihombing
- Division of Urology, Department of Surgery, Faculty of MediciDivision of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medanne, Universitas Sumatera Utara, Haji Adam Malik General Hospital.
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Graczyk S, Pasławski R, Grzeczka A, Pasławska U, Świeczko-Żurek B, Malisz K, Popat K, Sionkowska A, Golińska P, Rai M. Antimicrobial and Antiproliferative Coatings for Stents in Veterinary Medicine-State of the Art and Perspectives. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6834. [PMID: 37959431 PMCID: PMC10649059 DOI: 10.3390/ma16216834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
Microbial colonization in veterinary stents poses a significant and concerning issue in veterinary medicine. Over time, these pathogens, particularly bacteria, can colonize the stent surfaces, leading to various complications. Two weeks following the stent insertion procedure, the colonization becomes observable, with the aggressiveness of bacterial growth directly correlating with the duration of stent placement. Such microbial colonization can result in infections and inflammations, compromising the stent's efficacy and, subsequently, the animal patient's overall well-being. Managing and mitigating the impact of these pathogens on veterinary stents is a crucial challenge that veterinarians and researchers are actively addressing to ensure the successful treatment and recovery of their animal patients. In addition, irritation of the tissue in the form of an inserted stent can lead to overgrowth of granulation tissue, leading to the closure of the stent lumen, as is most often the case in the trachea. Such serious complications after stent placement require improvements in the procedures used to date. In this review, antibacterial or antibiofilm strategies for several stents used in veterinary medicine have been discussed based on the current literature and the perspectives have been drawn. Various coating strategies such as coating with hydrogel, antibiotic, or other antimicrobial agents have been reviewed.
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Affiliation(s)
- Szymon Graczyk
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Robert Pasławski
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Arkadiusz Grzeczka
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Urszula Pasławska
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Beata Świeczko-Żurek
- Department of Biomaterials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-229 Gdansk, Poland; (B.Ś.-Ż.); (K.M.)
| | - Klaudia Malisz
- Department of Biomaterials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-229 Gdansk, Poland; (B.Ś.-Ż.); (K.M.)
| | - Ketul Popat
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA;
| | - Alina Sionkowska
- Department of Biomaterials and Cosmetic Chemistry, Faculty of Chemistry, Nicolaus Copernicus University in Torun, Gagarina 7, 87-100 Torun, Poland
| | - Patrycja Golińska
- Department of Microbiology, Nicolaus Copernicus University, ul. Lwowska 1, 87-100 Torun, Poland;
| | - Mahendra Rai
- Department of Chemistry, Federal University of Piaui (UFPI), Teresina 64049-550, Brazil;
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Viola GM, Szvalb AD, Malek AE, Chaftari AM, Hachem R, Raad II. Prevention of device-related infections in patients with cancer: Current practice and future horizons. CA Cancer J Clin 2023; 73:147-163. [PMID: 36149820 PMCID: PMC9992006 DOI: 10.3322/caac.21756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Over the past several years, multifaceted advances in the management of cancer have led to a significant improvement in survival rates. Throughout patients' oncological journeys, they will likely receive one or more implantable devices for the administration of fluids and medications as well as management of various comorbidities and complications related to cancer therapy. Infections associated with these devices are frequent and complex, often necessitating device removal, increasing health care costs, negatively affecting quality of life, and complicating oncological care, usually leading to delays in further life-saving cancer therapy. Herein, the authors comprehensively review multiple evidence-based recommendations along with best practices, expert opinions, and novel approaches for the prevention of diverse device-related infections. The authors present many general principles for the prevention of these infections followed by specific device-related recommendations in a systematic manner. The continuous involvement and meaningful cooperation between regulatory entities, industry, specialty medical societies, hospitals, and infection control-targeted interventions, along with primary care and consulting health care providers, are all vital for the sustained reduction in the incidence of these preventable infections.
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Affiliation(s)
- George M Viola
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ariel D Szvalb
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre E Malek
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Tarawneh O, Abu Mahfouz H, Hamadneh L, Deeb AA, Al-Sheikh I, Alwahsh W, Fadhil Abed A. Assessment of persistent antimicrobial and anti-biofilm activity of p-HEMA hydrogel loaded with rifampicin and cefixime. Sci Rep 2022; 12:3900. [PMID: 35273262 PMCID: PMC8913786 DOI: 10.1038/s41598-022-07953-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/28/2022] [Indexed: 02/03/2023] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are nosocomial infections causing more than one million hospital cases annually. The progress of CAUTIs leads to severe health complications. Infections result in blockage of the medical device due to biofilm formation, which necessitates the replacement of the device. The objective of this study is to improve urological biomaterials to minimize microbial growth and reduce the incidence of CAUTIs. Challenges from mixed biofilm are crucial and need to be addressed in the development of new coating materials. Herein, an investigation highlighted the reduction of mixed biofilm overgrowth and attachment tendency on poly-2-hydroxyethyl methacrylate (p-HEMA) surface by loading the hydrogel with rifampicin (RIF), cefixime trihydrate (CFX), and combined ratios of RIF and CFX. Mixed biofilm-formation ability in (3:1) RIF: CFX-loading p-HEMA (F6) surface showed best tendency to resist form biofilm. Persistent antimicrobial activity increased in p-HEMA loaded with combined ratios of RIF and CFX surface compared to p-HEMA alone, antimicrobial activity lasted for 8 days. All fabricated films exhibited %cell viability higher than 75% on HEK 293 cells. The addition of RIF and CFX may improve the duration of urological device employment before replacement.
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Affiliation(s)
- Ola Tarawneh
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P. O. Box 130, Amman, 11733, Jordan.
| | - Hadeel Abu Mahfouz
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P. O. Box 130, Amman, 11733, Jordan
| | - Lama Hamadneh
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P. O. Box 130, Amman, 11733, Jordan
| | - Ahmad A Deeb
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P. O. Box 130, Amman, 11733, Jordan
| | - Iyad Al-Sheikh
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P. O. Box 130, Amman, 11733, Jordan
| | - Wasan Alwahsh
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P. O. Box 130, Amman, 11733, Jordan
| | - Abdulqader Fadhil Abed
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P. O. Box 130, Amman, 11733, Jordan
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Functional Properties of Polyurethane Ureteral Stents with PLGA and Papaverine Hydrochloride Coating. Int J Mol Sci 2021; 22:ijms22147705. [PMID: 34299324 PMCID: PMC8307159 DOI: 10.3390/ijms22147705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
Despite the obvious benefits of using ureteral stents to drain the ureters, there is also a risk of complications from 80-90%. The presence of a foreign body in the human body causes disturbances in its proper functioning. It can lead to biofilm formation on the stent surface, which may favor the development of urinary tract infections or the formation of encrustation, as well as stent fragmentation, complicating its subsequent removal. In this work, the effect of the polymeric coating containing the active substance-papaverine hydrochloride on the functional properties of ureteral stents significant for clinical practice were assessed. Methods: The most commonly clinically used polyurethane ureteral Double-J stent was selected for the study. Using the dip-coating method, the surface of the stent was coated with a poly(D,L-lactide-glycolide) (PLGA) coating containing the papaverine hydrochloride (PAP). In particular, strength properties, retention strength of the stent ends, dynamic frictional force, and the fluoroscopic visibility of the stent during X-ray imaging were determined. Results: The analysis of the test results indicates the usefulness of a biodegradable polymer coating containing the active substance for the modification of the surface of polyurethane ureteral stents. The stents coated with PLGA+PAP coating compared to polyurethane stents are characterized by more favorable strength properties, the smaller value of the dynamic frictional force, without reducing the fluoroscopic visibility.
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Lopes RI, Perrella R, Watanabe CH, Beltrame F, Danilovic A, Murta CB, Claro JFDA, Vicentini FC. Patients with encrusted ureteral stents can be treated by a single session combined endourological approach. Int Braz J Urol 2021; 47:574-583. [PMID: 33621006 PMCID: PMC7993973 DOI: 10.1590/s1677-5538.ibju.2020.0511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/22/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To describe our experience in the management of retained encrusted ureteral stents using a single session combined endourological approach. MATERIALS AND METHODS Patients with retained encrusted ureteral stents who had been submitted to a single session combined endourological approach from June 2010 to June 2018 were prospectively evaluated. Patients were divided according to the Forgotten-Encrusted-Calcified (FECal) classification. The stone burden, surgical intervention, number of interventions until stone free status, operation time, hospital stay, complications, stone analysis, and stone-free rate were compared between groups. ANOVA was used to compare numerical variables, and the Mann-Whitney or Chi-square test to compare categorical variables between groups. RESULTS We evaluated 50 patients with a mean follow-up of 2.9±1.4 years (mean±SD). The groups were comparable in terms of age, sex, laterality, BMI, comorbidities, ASA, reason for stent passage, and indwelling time. The stone burden was higher for grades IV and V (p=0.027). Percutaneous nephrolithotomy was the most common procedure (p=0.004) for grades IV and V. The number of procedures until the patients were stone-free was 1.92±1.40, and the hospital stay (4.2±2.5 days), complications (22%), and stone analysis (66% calcium oxalate) were similar between groups. The stone-free rate was lower in grades III to V (60%, 54.5%, and 50%). CONCLUSIONS The endoscopic combined approach in the supine position is a safe and feasible technique that allows removal of retained and encrusted stents in a single procedure. The FECal classification seems to be useful for surgical planning.
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Affiliation(s)
- Roberto Iglesias Lopes
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | | | - Alexandre Danilovic
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | - Fabio Carvalho Vicentini
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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Biodegradation and Antimicrobial Properties of Zinc Oxide–Polymer Composite Materials for Urinary Stent Applications. COATINGS 2020. [DOI: 10.3390/coatings10101002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Research advancements in the field of urinary stents have mainly been in the selection of materials and coatings to address commonly faced problems of encrustation and bacterial adhesion. In this study, polylactic acid (PLA) and polypropylene (PP) were evaluated with zinc oxide (ZnO) coating to assess its ability to reduce or eliminate the problems of encrustation and bacteria adhesion. PLA and PP films were prepared via twin screw extrusion. ZnO microparticles were prepared using sol-gel hydrothermal synthesis. The as-prepared ZnO microparticles were combined in the form of a functional coating and deposited on both polymer substrates using a doctor blade technique. The ZnO-coated PP and PLA samples as well as their uncoated counterparts were characterized from the physicochemical standpoints, antibacterial and biodegradation properties. The results demonstrated that both the polymers preserved their mechanical and thermal properties after coating with ZnO, which showed a better adhesion on PLA than on PP. Moreover, the ZnO coating successfully enhanced the antibacterial properties with respect to bare PP/PLA substrates. All the samples were investigated after immersion in simulated body fluid and artificial urine. The ZnO layer was completely degraded following 21 days immersion in artificial urine irrespective of the substrate, with encrustations more evident in PP and ZnO-coated PP films than PLA and ZnO-coated PLA films. Overall, the addition of ZnO coating on PLA displayed better adhesion, antibacterial activity and delayed the deposition of encrustations in comparison to PP substrates.
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He M, Lin X, Lei M, Xu X, He Z. Risk Factors of Urinary Tract Infection After Ureteral Stenting in Patients with Renal Colic During Pregnancy. J Endourol 2020; 35:91-96. [PMID: 32680438 DOI: 10.1089/end.2020.0618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: To investigate risk factors associated with urinary tract infection (UTI), following ureteral stenting, for patients with renal colic during pregnancy. Patients and Methods: Patients with renal colic during pregnancy who underwent ureteral stenting in The First Affiliated Hospital of Guangzhou Medical University between 2009 and 2019 were examined retrospectively. Ureteral stenting patients who had UTIs after hospital discharge and before delivery were classified as the infected group. Multivariate logistic regression analysis was used to assess the risk factors associated with UTI after ureteral stenting. Results: A total of 102 patients were enrolled into the study. Mean age was 30 years (interquartile range [IQR]: 26-33 years) and mean gestation age was 22 weeks (IQR: 18-28 weeks). UTI occurred in 21 patients (20.6%). Compared with noninfected patients, infected patients had a higher rate of positive urine culture (52.4% vs 13.6%, p = 0.000), kidney stones ≥10 mm (81% vs 35.8%, p = 0.000), residual stones after ureteral stenting (71.4% vs 43.2%, p = 0.021), and different surgical indications and gestational ages (18 vs 23 weeks, p = 0.00). Multifactor analysis showed that gestational age, positive urine culture (odds ratio [OR] = 6.233, 95% confidence interval [CI]: 1.830-21.227), and stones ≥10 mm (OR = 0.124, 95% CI: 0.031-0.495) were independent risk factors for UTI after ureteral stenting in patients with renal colic. In the infection group, Escherichia coli was the most commonly found organism (47.4%). Conclusions: Gestational age, positive urine culture before surgery, and stone ≥10 mm were risk factors for UTI after ureteral stenting in pregnant patients with renal colic. E. coli was the main pathogen of UTI after this procedure. Preoperative anti-infection treatment needs to be based on drugs that are sensitive to E. coli.
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Affiliation(s)
- Maomao He
- Department of Obstetrics and Gynecology and The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoting Lin
- Department of Obstetrics and Gynecology and The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming Lei
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaolan Xu
- Department of Obstetrics and Gynecology and The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhihui He
- Department of Obstetrics and Gynecology and The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Biodegradable and Drug-Eluting Inorganic Composites Based on Mesoporous Zinc Oxide for Urinary Stent Applications. MATERIALS 2020; 13:ma13173821. [PMID: 32872464 PMCID: PMC7504493 DOI: 10.3390/ma13173821] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 01/11/2023]
Abstract
Conventional technologies for ureteral stent fabrication suffer from major inconveniences such as the development of encrustations and bacteria biofilm formation. These drawbacks typically lead to the failure of the device, significant patient discomfort and an additional surgery to remove and replace the stent in the worst cases. This work focuses on the preparation of a new nanocomposite material able to show drug elution properties, biodegradation and eventually potential antibacterial activity. Poly(2-hydroxyethyl methacrylate) or the crosslinked poly(2-hydroxyethyl methacrylate)-co-poly(acrylic acid) hydrogels were prepared by the radical polymerization method and combined with a biodegradable and antibacterial filling agent, i.e., flower-like Zinc Oxide (ZnO) micropowders obtained via the hydrothermal route. The physico-chemical analyses revealed the correct incorporation of ZnO within the hydrogel matrix and its highly mesoporous structure and surface area, ideal for drug incorporation. Two different anti-inflammatory drugs (Ibuprofen and Diclofenac) were loaded within each composite and the release profile was monitored up to two weeks in artificial urine (AU) and even at different pH values in AU to simulate pathological conditions. The addition of mesoporous ZnO micropowders to the hydrogel did not negatively affect the drug loading properties of the hydrogel and it was successfully allowed to mitigate undesirable burst-release effects. Furthermore, the sustained release of the drugs over time was observed at neutral pH, with kinetic constants (k) as low as 0.05 h−1. By exploiting the pH-tunable swelling properties of the hydrogel, an even more sustained release was achieved in acidic and alkaline conditions especially at short release times, with a further reduction of burst effects (k ≈ 0.01–0.02 h−1). The nanocomposite system herein proposed represents a new material formulation for preparing innovative drug eluting stents with intrinsic antibacterial properties.
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Carvalho I, Dias N, Henriques M, Calderon V S, Ferreira P, Cavaleiro A, Carvalho S. Antibacterial Effects of Bimetallic Clusters Incorporated in Amorphous Carbon for Stent Application. ACS APPLIED MATERIALS & INTERFACES 2020; 12:24555-24563. [PMID: 32383580 DOI: 10.1021/acsami.0c02821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this work is the development of Ag/a:C and Ag-Au/a:C coatings for ureteral stents, to provide them with antimicrobial characteristics. Silver was selected because of its well-known antibacterial properties, while gold was included to assess its capacity to accelerate the silver ion release forming a galvanic couple between Au and Ag. Thus, the metallic (Ag) and bimetallic clusters (Ag-Au) were produced by three different configurations: (i) unbalanced magnetron sputtering (conventional sputtering), (ii) plasma gas condensation process, and by (iii) a combination between both previous approaches. Coatings with Ag-Au bimetallic clusters were characterized by transmission electron microscopy (TEM) in order to study the arrangement (alloy, core-shell, and galvanic couple) of these particles in the carbon matrix. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was used to quantify the Ag ions released through artificial urine from the different coatings deposited on thermoplastic polyurethane tape (one of the materials used in the manufacture of the ureteral stent ). Then, the antibacterial and cytotoxicity properties of Ag and Ag-Au/a:C coatings were evaluated. TEM shows that a biphasic structure was not detected, thus not allowing to anticipate the establishment of a galvanic couple. The ICP-OES results demonstrate that the silver ionization is mainly a function of the amount of silver incorporated in the amorphous carbon (a:C) matrix, and the formation of a bimetallic alloy has a detrimental effect on release of the silver ions. The antibacterial activity was regulated by the silver ionization mechanisms because the coatings with higher Ag release had a higher antibacterial activity.
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Affiliation(s)
- Isabel Carvalho
- SEG-CEMMPRE Mechanical Engineering Department, University of Coimbra, 3030-788 Coimbra, Portugal
- CEB, Centre of Biological Engineering, LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus of Gualtar, 4710-057 Braga, Portugal
- CFUM-UP, Centro de Física das Universidades do Minho e do Porto, University of Minho, Campus of Azurém, 4800-058 Guimarães, Portugal
| | - Nicolina Dias
- CEB, Centre of Biological Engineering, University of Minho, Campus of Gualtar, 4710-057 Braga, Portugal
| | - Mariana Henriques
- CEB, Centre of Biological Engineering, LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus of Gualtar, 4710-057 Braga, Portugal
| | - Sebastian Calderon V
- INL-International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga s/n, 4715-330 Braga, Portugal
| | - Paulo Ferreira
- INL-International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga s/n, 4715-330 Braga, Portugal
- Mechanical Engineering Department and IDMEC, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
- Materials Science and Engineering Program and Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Albano Cavaleiro
- SEG-CEMMPRE Mechanical Engineering Department, University of Coimbra, 3030-788 Coimbra, Portugal
- IPN-LED & MAT Instituto Pedro Nunes, Laboratory for Wear, Testing & Materials, Rua Pedro Nunes, 3030-199 Coimbra, Portugal
| | - Sandra Carvalho
- SEG-CEMMPRE Mechanical Engineering Department, University of Coimbra, 3030-788 Coimbra, Portugal
- CFUM-UP, Centro de Física das Universidades do Minho e do Porto, University of Minho, Campus of Azurém, 4800-058 Guimarães, Portugal
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12
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A Microfluidic-Based Investigation of Bacterial Attachment in Ureteral Stents. MICROMACHINES 2020; 11:mi11040408. [PMID: 32295085 PMCID: PMC7231375 DOI: 10.3390/mi11040408] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/24/2022]
Abstract
Obstructions of the ureter lumen can originate from intrinsic or extrinsic factors, such as kidney stones, tumours, or strictures. These can affect the physiological flow of urine from the kidneys to the bladder, potentially causing infection, pain, and kidney failure. To overcome these complications, ureteral stents are often deployed clinically in order to temporarily re-establish urinary flow. Despite their clinical benefits, stents are prone to encrustation and biofilm formation that lead to reduced quality of life for patients; however, the mechanisms underlying the formation of crystalline biofilms in stents are not yet fully understood. In this study, we developed microfluidic-based devices replicating the urodynamic field within different configurations of an occluded and stented ureter. We employed computational fluid dynamic simulations to characterise the flow dynamic field within these models and investigated bacterial attachment (Pseudomonas fluorescens) by means of crystal violet staining and fluorescence microscopy. We identified the presence of hydrodynamic cavities in the vicinity of a ureteric occlusion, which were characterised by low levels of wall shear stress (WSS < 40 mPa), and observed that initiation of bacterial attachment occurred in these specific regions of the stented ureter. Notably, the bacterial coverage area was directly proportional to the number of cavities present in the model. Fluorescence microscopy confirmed that the number density of bacteria was greater within cavities (3 bacteria·mm-2) when compared to side-holes of the stent (1 bacterium·mm-2) or its luminal surface (0.12·bacteria mm-2). These findings informed the design of a novel technological solution against bacterial attachment, which reduces the extent of cavity flow and increases wall shear stress over the stent's surface.
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13
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Jaworska J, Włodarczyk J, Karpeta-Jarząbek P, Janeczek H, Stojko M, Kasperczyk J. Electrospun, drug-enriched bioresorbable nonwovens based on poly(glycolide-ɛ-caprolactone) and poly(d,l-lactide-glycolide) for urological applications. Polym Degrad Stab 2019. [DOI: 10.1016/j.polymdegradstab.2019.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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14
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Abstract
Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.
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Affiliation(s)
- Minh Huynh
- Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France.
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15
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Apitius L, Buschmann S, Bergs C, Schönauer D, Jakob F, Pich A, Schwaneberg U. Biadhesive Peptides for Assembling Stainless Steel and Compound Loaded Micro‐Containers. Macromol Biosci 2019; 19:e1900125. [DOI: 10.1002/mabi.201900125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/18/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Lina Apitius
- DWI – Leibniz Institute for Interactive Materials Forckenbeckstrasse 50 52056 Aachen Germany
- Institute of BiotechnologyRWTH Aachen University Worringerweg 3 52074 Aachen Germany
| | - Sven Buschmann
- DWI – Leibniz Institute for Interactive Materials Forckenbeckstrasse 50 52056 Aachen Germany
| | - Christian Bergs
- DWI – Leibniz Institute for Interactive Materials Forckenbeckstrasse 50 52056 Aachen Germany
| | - David Schönauer
- SeSaM‐Biotech GmbH Forckenbeckstrasse 50 52074 Aachen Germany
| | - Felix Jakob
- DWI – Leibniz Institute for Interactive Materials Forckenbeckstrasse 50 52056 Aachen Germany
- Institute of BiotechnologyRWTH Aachen University Worringerweg 3 52074 Aachen Germany
| | - Andrij Pich
- DWI – Leibniz Institute for Interactive Materials Forckenbeckstrasse 50 52056 Aachen Germany
- Functional and Interactive PolymersInstitute of Technical and Macromolecular ChemistryRWTH Aachen University Worringerweg 2 52074 Aachen Germany
| | - Ulrich Schwaneberg
- DWI – Leibniz Institute for Interactive Materials Forckenbeckstrasse 50 52056 Aachen Germany
- Institute of BiotechnologyRWTH Aachen University Worringerweg 3 52074 Aachen Germany
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16
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Lim KS, Lim YW, Yong DZ, Hao Y, Ho HS, Ng LG, Sim AS. Two Weeks Too Long: Optimal Duration for Ureteral Prestenting and Its Physiologic Effects on the Ureter in a Yorkshire-Landrace Pig Model. J Endourol 2019; 33:325-330. [DOI: 10.1089/end.2018.0872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Kheng S. Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Yong W. Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Daniel Z.P. Yong
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ying Hao
- Health Services Research Unit, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Henry S.S. Ho
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Lay G. Ng
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Allen S.P. Sim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
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17
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18
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Beysens M, Tailly TO. Ureteral stents in urolithiasis. Asian J Urol 2018; 5:274-286. [PMID: 30364608 PMCID: PMC6197553 DOI: 10.1016/j.ajur.2018.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/29/2018] [Accepted: 05/25/2018] [Indexed: 02/08/2023] Open
Abstract
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.
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Affiliation(s)
| | - Thomas O. Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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19
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Abstract
Purpose of Review There are three technological parameters that play a key role on the performance of an ideal stent. These are its material, design and surface coating. This article highlights some fundamental developments that took place in these three areas of stent’s technology, in order to contribute to the identification of an ideal stent. Recent Findings In addition to technological developments concerning stent’s material, design and surface coating, the flow dynamic performance of stents has recently attracted increasing attention. Notably, it has been postulated that the local flow field in a stent is correlated with the deposition of crystals and microorganisms. These findings could potentially revolutionise future stent’s designs, and complement developments made on materials and coatings. Summary The most relevant changes in materials, designs and surface coatings of ureteric stents are reviewed in this article. These are described in the context of a specific cause of stent’s failure they aim to address, with a particular focus on encrustation and biofilm formation.
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Affiliation(s)
- Ali Mosayyebi
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK. .,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK.
| | - Costantino Manes
- Department of Environment, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Dario Carugo
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK.,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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20
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Cauda V, Chiodoni A, Laurenti M, Canavese G, Tommasi T. Ureteral double-J stents performances toward encrustation after long-term indwelling in a dynamic in vitro model. J Biomed Mater Res B Appl Biomater 2016; 105:2244-2253. [PMID: 27459232 DOI: 10.1002/jbm.b.33756] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/14/2016] [Accepted: 07/05/2016] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Valentina Cauda
- Center for Sustainable Futures, Istituto Italiano di Tecnologia, 10129, Turin, Italy.,Department of Applied Science and Technology, Politecnico di Torino, 10129, Turin, Italy
| | - Angelica Chiodoni
- Center for Sustainable Futures, Istituto Italiano di Tecnologia, 10129, Turin, Italy
| | - Marco Laurenti
- Department of Applied Science and Technology, Politecnico di Torino, 10129, Turin, Italy
| | - Giancarlo Canavese
- Department of Applied Science and Technology, Politecnico di Torino, 10129, Turin, Italy
| | - Tonia Tommasi
- Center for Sustainable Futures, Istituto Italiano di Tecnologia, 10129, Turin, Italy
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21
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Zhang K, Wang X, Guan F, Li Q, Li J. Immobilization of Ophiopogonin D on stainless steel surfaces for improving surface endothelialization. RSC Adv 2016. [DOI: 10.1039/c6ra17584h] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Ophiopogonin D, a traditional Chinese medicine, was immobilized onto the surface of cardiovascular 316L SS material to improve surface endothelialization.
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Affiliation(s)
- Kun Zhang
- School of Life Science
- Zhengzhou University
- Zhengzhou 450001
- PR China
- National Center for International Research of Micro-nano Molding Technology
| | - Xiaofeng Wang
- National Center for International Research of Micro-nano Molding Technology
- Key Laboratory for Micro Molding Technology of Henan Province
- Zhengzhou 450001
- PR China
| | - Fangxia Guan
- School of Life Science
- Zhengzhou University
- Zhengzhou 450001
- PR China
| | - Qian Li
- National Center for International Research of Micro-nano Molding Technology
- Key Laboratory for Micro Molding Technology of Henan Province
- Zhengzhou 450001
- PR China
| | - Jingan Li
- School of Material Science and Engineering
- Zhengzhou University
- Zhengzhou 450001
- PR China
- National Center for International Research of Micro-nano Molding Technology
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