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Li K, Liu X, Fan Y, Feng S, Chen D. Preventive effect of surface charge on encrustation of biodegradable ureteral stents. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2023; 34:258-275. [PMID: 35984741 DOI: 10.1080/09205063.2022.2115760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Prevention of encrustation on the surface has always been the biggest challenge for urological implants. In the field of ureteral stent design, biodegradability has attracted much attention in recent years, because biodegradable ureteral stents not only avoid secondary intervention, but also prevent encrustation due to surface renewal by degradation process. Furthermore, researches have focus on some surface parameters to provide guidance for the development of stent materials, such as hydrophilicity or surface charge. In this work, we synthesized two types of poly(ester-carbonate)s, poly(L-lactide-co-5-amino-1,3-dioxan-2-one) (P(LA-co-AC)) containing amino, and poly (L-lactide-co-5-methyl-5-carboxyl-1,3-dioxan-2-one) (P(LA-co-MCC)) containing carboxyl. Blending P(LA-co-AC) and P(LA-co-MCC) with poly(L-lactide-co-Ɛ-caprolactone) (PLACL) respectively, two types of ureteral stent materials were prepared. Due to the influence of ions formed by the dissociation of amino and carboxyl, two types of materials show differences in surface charge analyses. We further developed a dynamic urinary extracorporeal circulation (DUEC) system to assess in vitro encrustation of materials with different surface charges. The results of this comparative study identified that the materials with strong negative surface charge were most favorable for use as ureteral stent, and provided a new approach to surmount the problems faced by urological surgery which complied with the future trend of biodegradable ureteral stent design.
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Affiliation(s)
- Kaiqi Li
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, PR China.,University of Chinese Academy of Sciences, Beijing, PR China
| | - Xiliang Liu
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, PR China.,University of Chinese Academy of Sciences, Beijing, PR China
| | - Youkun Fan
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, PR China.,University of Chinese Academy of Sciences, Beijing, PR China
| | - Shaomin Feng
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, PR China.,University of Chinese Academy of Sciences, Beijing, PR China
| | - Dongliang Chen
- Chengdu Institute of Organic Chemistry, Chinese Academy of Sciences, Chengdu, PR China
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Wu Y, Cao Y, Liu H, Pan X, Wang J, Huang Y, Qi J, Cui X, Zhang L, Ding J. Comparison of Ureteral Stents on Drainage Performance Under Extrinsic Compression. BJU Int 2022; 130:343-349. [PMID: 35137515 DOI: 10.1111/bju.15707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE By investigating deformation and flow velocity of three commonly used, readily accessible ureteral stents under variant compression and surface change at three time points (new, 1 month or 3 months after implantation), we share our center's experience dealing with ureteral obstruction especially the malignant ones. MATERIALS AND METHODS Ureteral double-J (DJ) stents including Cook Universa Soft, Kang Yi Bo (KYB) antireflux and Urovision Visiostar ESWL DJ stents went though scanning microscopic (SEM) analysis. Compression-deformation was measured using digital force gauge. Intraluminal flow velocity was tested with the stents under different compression levels. RESULT Urovision Visiostar demonstrated significantly better anti-compression capability. Cook Universa Soft and KYB antireflux showed favorable draining velocity without compression, but the velocity dropped heavily under compression; the velocity of KYB antireflux reduced heavily after 3 months of implantation; Urovision Visiostar achieved the best draining effect under compression at all three time points. CONCLUSION The Urovision Visiostar DJ stent demonstrated significantly greater resistance to compression than the other two, and better drainage under compression. Patients with benign or malignant ureteral compression might benefit from using the Urovision Visiostar stents. Large prospective clinical trials are needed for confirmation.
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Affiliation(s)
- Yanyuan Wu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Yiqun Cao
- Department of Operation Room, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Hailong Liu
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Xiuwu Pan
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Jie Wang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Yunteng Huang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Jun Qi
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Xingang Cui
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Lin Zhang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
| | - Jie Ding
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine
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Janssen P, Tailly T. New Stent Technologies. Urol Clin North Am 2021; 49:185-196. [PMID: 34776051 DOI: 10.1016/j.ucl.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ureteral stents are an indispensable part of any (endo-) urologic practice. Despite the widely demonstrated advantages of stents, they also carry a considerable risk of side effects and complications, such as urinary symptoms, pain, hematuria, decreased quality of life, stent-related infection, and encrustation. Multiple pathways in preventing or mitigating these side effects and complications and improving stent efficacy have been and are being investigated, including stent architecture and design, biomaterials, and coatings. This article provides an update on currently researched and available stents as well as future perspectives.
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Affiliation(s)
- Pieter Janssen
- Department of Urology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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Kajzer W, Szewczenko J, Kajzer A, Basiaga M, Jaworska J, Jelonek K, Nowińska K, Kaczmarek M, Orłowska A. Physical Properties of Electropolished CoCrMo Alloy Coated with Biodegradable Polymeric Coatings Releasing Heparin after Prolonged Exposure to Artificial Urine. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2551. [PMID: 34069039 PMCID: PMC8156080 DOI: 10.3390/ma14102551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/02/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
In this study, we aimed to determine the effect of long-term exposure to artificial urine on the physical properties of CoCrMo alloy with biodegradable heparin-releasing polymeric coatings. Variants of polymer coatings of poly(L,L-lactide-ɛ-caprolactone) (P(L,L-L/CL)) and poly(D,L-lactide-ɛ-caprolactone) (P(D,L-L/CL)) constituting the base for heparin-releasing (HEP) polyvinyl alcohol (PVA) coatings were analyzed. The coatings were applied by the dip-coating method. Heparin was used to counteract the incrustation process in the artificial urine. The study included tests of wettability, resistance to pitting and crevice corrosion, determination of the mass density of metal ions penetrating into the artificial urine, and the kinetics of heparin release. In addition, microscopic observations of surface roughness and adhesion to the metal substrate were performed. Electrolytically polished CoCrMo samples (as a reference level) and samples with polymer coatings were used for the tests. The tests were conducted on samples in the initial state and after 30, 60, and 90 days of exposure to artificial urine. The analysis of the test results shows that the polymer coatings contribute by improving the resistance of the metal substrate to pitting and crevice corrosion in the initial state and reducing (as compared with the metal substrate) the mass density of metal ion release into the artificial urine. Moreover, the PVA + HEP coating, regardless of the base polymer coatings used, contributes to a reduction in the incrustation process in the first 30 days of exposure to the artificial urine.
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Affiliation(s)
- Wojciech Kajzer
- Department of Biomaterials and Medical Devices Engineering, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (J.S.); (A.K.); (M.B.); (M.K.); (A.O.)
| | - Janusz Szewczenko
- Department of Biomaterials and Medical Devices Engineering, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (J.S.); (A.K.); (M.B.); (M.K.); (A.O.)
| | - Anita Kajzer
- Department of Biomaterials and Medical Devices Engineering, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (J.S.); (A.K.); (M.B.); (M.K.); (A.O.)
| | - Marcin Basiaga
- Department of Biomaterials and Medical Devices Engineering, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (J.S.); (A.K.); (M.B.); (M.K.); (A.O.)
| | - Joanna Jaworska
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, 41-819 Zabrze, Poland; (J.J.); (K.J.)
| | - Katarzyna Jelonek
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, 41-819 Zabrze, Poland; (J.J.); (K.J.)
| | - Katarzyna Nowińska
- Department of Applied Geology, Faculty of Mining, Safety Engineering and Industrial Automation, Silesian University of Technology, 44-100 Gliwice, Poland;
| | - Marcin Kaczmarek
- Department of Biomaterials and Medical Devices Engineering, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (J.S.); (A.K.); (M.B.); (M.K.); (A.O.)
| | - Ada Orłowska
- Department of Biomaterials and Medical Devices Engineering, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (J.S.); (A.K.); (M.B.); (M.K.); (A.O.)
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Arkusz K, Pasik K, Halinski A, Halinski A. Surface analysis of ureteral stent before and after implantation in the bodies of child patients. Urolithiasis 2020; 49:83-92. [PMID: 32909098 PMCID: PMC7867540 DOI: 10.1007/s00240-020-01211-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/25/2020] [Indexed: 02/08/2023]
Abstract
The aim of this work was to determine which part of a double-J ureteral stent (DJ stents) showed the highest tendency to crystal, calculi, and biofilm deposition after ureterorenoscopic-lithotripsy procedure (URS-L) to treat calcium oxalate stones. Additionally, the mechanical strength and the stiffness of DJ stents were evaluated before and after exposure to urine. Obtained results indicated that the proximal (renal pelvis) and distal (urinary bladder) part is the most susceptible for post-URS-L fragments and urea salt deposition. Both, the outer and inner surfaces of the DJ ureteral stents were completely covered even after 7 days of implantation. Encrustation of DJ stents during a 31-day period results in reducing the Young’s modulus by 27–30%, which confirms the loss of DJ stent elasticity and increased probability of cracks or interruption. Performed analysis pointed to the need to use an antibacterial coating in the above-mentioned part of the ureteral stent to prolong its usage time and to prevent urinary tract infection.
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Affiliation(s)
- Katarzyna Arkusz
- Department of Biomedical Engineering, Faculty of Mechanical Engineering, University of Zielona Gora, 9 Licealna Street, 65-417, Zielona Gora, Poland.
| | - Kamila Pasik
- Department of Biomedical Engineering, Faculty of Mechanical Engineering, University of Zielona Gora, 9 Licealna Street, 65-417, Zielona Gora, Poland
| | - Andrzej Halinski
- Department of Paediatric Urology, Cherry Clinic, Anieli Krzywon 2 Street, 65-534, Zielona Gora, Poland
| | - Adam Halinski
- Department of Paediatric Urology, Cherry Clinic, Anieli Krzywon 2 Street, 65-534, Zielona Gora, Poland
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Ho BSH, Chiu PKF, Lam W, Wong JHF, Wong CKW, Lai TCT, Tsang C, Ng ATL, Chan C, Ma W, Ng C, Tsu JHL. Risk factors in the prediction of long-term patency of Resonance metallic ureteric stent in malignant ureteric obstruction. BJUI COMPASS 2020; 1:74-81. [PMID: 35474710 PMCID: PMC8988516 DOI: 10.1002/bco2.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives Cancer is the second leading cause of death globally in 2018 with an estimated 9.6 million deaths. The costs of managing malignant ureteric obstruction (MUO) is a significant burden to any healthcare system. However, the management of MUO has long been a challenge for urologists. The standard options of percutaneous nephrostomy or polymer double J stents are fraught with problems. We report a large patient series with long-term follow-up in the use of Resonance metallic ureteric stents to relieve MUO, and identification of risk factors associated with stent failure. Patients and methods All patients with MUO who were arranged to have Resonance metallic ureteric stent insertion at two university hospitals were included in this cohort study, starting from June 2011 to July 2016. Data were retrieved retrospectively. The primary outcome was the total duration of stent patency before stent failure due to malignant disease progression. Stent failure was defined as ureteric obstruction identified on imaging (functional radioisotope scan or antegrade pyelogram), acute renal failure resolved by subsequent percutaneous nephrostomy, or any other cause requiring stent removal prematurely. Secondary outcomes were identification of factors associated with stent failure, grade III or above complication, and development of a risk-adopted model to predict metallic ureteric stent patency rates in MUO patients. Median duration of functioning metallic ureteric stent was determined with Kaplan-Meier survival curve. Results A total of 124 renal units in 95 patients with MUO were eligible for the study, with a median follow-up period of 22.9 months. About 106 (85.5%) renal units had successful metallic stent insertion, of whom 41 (33.1%) renal units ultimately progressed to ureteric obstruction despite the metallic stents, and required subsequent insertion of nephrostomies. Median duration of functioning metallic ureteric stents was 25 months. Female gender (HR 3.0, 95% CI: 1.3-7.2, P = .014) and suspicious bladder lesion (HR 2.9, 95% CI: 1.4-6.2, P = .005) were independent risk factors for stent failure, respectively. Stratifying patients into low (0 risk factor), intermediate (1 risk factor), and high (2 risk factors) risk groups, we found that this could predict the duration of stent patency in MUO with the metallic stents. (Low risk: 30.3 months vs intermediate group: 17.8 months vs high risk: 4.9 months, P < .001). Conclusion Resonance metallic ureteral stents are able provide a median of 25 months of ureteric drainage in patients with MUO. Determining whether a patient has one or both risks factors (female gender and bladder lesion) will allow one to estimate the duration of metallic stent patency, which in turn may aid in determining cost-effectiveness in individual patients.
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Affiliation(s)
- Brian S. H. Ho
- Division of UrologyDepartment of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Peter K. F. Chiu
- Division of UrologyDepartment of SurgeryPrince of Wales HospitalHong KongHong Kong
| | - Wayne Lam
- Division of UrologyDepartment of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Julius H. F. Wong
- Division of UrologyDepartment of SurgeryPrince of Wales HospitalHong KongHong Kong
| | - Charles K. W. Wong
- Division of UrologyDepartment of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Terence C. T. Lai
- Division of UrologyDepartment of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Chiu‐Fung Tsang
- Division of UrologyDepartment of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Ada T. L. Ng
- Division of UrologyDepartment of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Chi‐Kwok Chan
- Division of UrologyDepartment of SurgeryPrince of Wales HospitalHong KongHong Kong
| | - Wai‐Kit Ma
- Division of UrologyDepartment of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
| | - Chi‐Fai Ng
- Division of UrologyDepartment of SurgeryPrince of Wales HospitalHong KongHong Kong
- SH Ho Urology CentreThe Chinese University of Hong KongHong KongHong Kong
| | - James H. L. Tsu
- Division of UrologyDepartment of SurgeryQueen Mary HospitalThe University of Hong KongHong KongHong Kong
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Paramitha D, Chabaud S, Bolduc S, Hermawan H. Biological Assessment of Zn-Based Absorbable Metals for Ureteral Stent Applications. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E3325. [PMID: 31614757 PMCID: PMC6829415 DOI: 10.3390/ma12203325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/02/2023]
Abstract
The use of ureteral stents to relieve urinary tract obstruction is still challenged by the problems of infection, encrustation, and compression, leading to the need for early removal procedures. Biodegradable ureteral stents, commonly made of polymers, have been proposed to overcome these problems. Recently, absorbable metals have been considered as potential materials offering both biodegradation and strength. This work proposed zinc-based absorbable metals by firstly evaluating their cytocompatibility toward normal primary human urothelial cells using 2D and 3D assays. In the 2D assay, the cells were exposed to different concentrations of metal extracts (i.e., 10 mg/mL of Zn-1Mg and 8.75 mg/mL of Zn-0.5Al) for up to 3 days and found that their cytoskeletal networks were affected but were recovered at day 3, as observed by immunofluorescence. In the 3D ureteral wall tissue construct, the cells formed a multilayered urothelium, as found in native tissue, with the presence of tight junctions at the superficial layer and laminin at the basal layer, indicating a healthy tissue condition even with the presence of the metal samples for up to 7 days of exposure. The basal cells attached to the metal surface as seen in a natural spreading state with pseudopodia and fusiform morphologies, indicating that the metals were non-toxic.
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Affiliation(s)
- Devi Paramitha
- Department of Mining, Metallurgical and Materials Engineering & CHU de Québec Research Center, Laval University, Quebec City, QC G1V 0A6, Canada.
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Division of Regenerative Medicine, CHU de Québec Research Center, Laval University, Quebec City, QC G1J 1Z4, Canada.
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Division of Regenerative Medicine, CHU de Québec Research Center, Laval University, Quebec City, QC G1J 1Z4, Canada.
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Division of Regenerative Medicine, CHU de Québec Research Center, Laval University, Quebec City, QC G1J 1Z4, Canada.
| | - Hendra Hermawan
- Department of Mining, Metallurgical and Materials Engineering & CHU de Québec Research Center, Laval University, Quebec City, QC G1V 0A6, Canada.
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Burke G, Cao Z, Devine DM, Major I. Preparation of Biodegradable Polyethylene Glycol Dimethacrylate Hydrogels via Thiol-ene Chemistry. Polymers (Basel) 2019; 11:E1339. [PMID: 31412552 PMCID: PMC6722562 DOI: 10.3390/polym11081339] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/17/2022] Open
Abstract
Through the control of the molecular weight, water content and monomer concentration, polyethylene glycol dimethacrylate (PEGDMA) based hydrogels have been adapted for numerous applications, including as structural scaffolds, drug delivery vehicles and cell carriers. However, due to the low biodegradability rates, the use of PEGDMA in tissue engineering has been limited. Thiol-based monomers have been shown to improve the degradation rates of several PEG-based hydrogels, though their impact on several material properties has not been as well defined. In this work, several mercaptopropianoates, as well as mercaptoacetates, were mixed with PEGDMA and copolymerized. Following an initial polymerization check, it was determined that mercaptoacetate-based thiol monomers did not polymerize in the presence of PEGDMA, whereas mercaptopropionates were more successful. The wettability, and the compressive and tensile strength, in addition to the thermal properties, were determined for successfully copolymerized samples via a combination of differential scanning calorimetry, dynamic mechanical analysis, unconfined compression, and goniometry. Further study determined that dipentaerythritol hexa(3-mercaptopropionate) (DiPETMP) successfully enhanced the biodegradability of PEGDMA.
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Affiliation(s)
- Gavin Burke
- Materials Research Institute, Athlone Institute of Technology, Dublin Road, Co. Westmeath N37 HD68, Ireland
| | - Zhi Cao
- Materials Research Institute, Athlone Institute of Technology, Dublin Road, Co. Westmeath N37 HD68, Ireland
| | - Declan M Devine
- Materials Research Institute, Athlone Institute of Technology, Dublin Road, Co. Westmeath N37 HD68, Ireland
| | - Ian Major
- Materials Research Institute, Athlone Institute of Technology, Dublin Road, Co. Westmeath N37 HD68, Ireland.
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Chen Y, Liu CY, Zhang ZH, Xu PC, Chen DG, Fan XH, Ma JC, Xu YP. Malignant ureteral obstruction: experience and comparative analysis of metallic versus ordinary polymer ureteral stents. World J Surg Oncol 2019; 17:74. [PMID: 31039812 PMCID: PMC6492337 DOI: 10.1186/s12957-019-1608-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To study the outcome and experience of using metallic stents in treating patients with malignant ureteral obstruction (MUO). METHODS Seventy-six patients with MUO were assigned to the metallic stent group (MSG) or the ordinary polymer stent group (OPSG) according to the different materials. The success rate of the operation, duration of operation, patency rate serum creatinine values ,postoperative complications and QOL scores were compared between the two groups. RESULTS In the OPSG and MSG, the success rates of the operation were 95.5% and 96.9%, respectively, and the durations of the operation were 20.6 ± 2.2 min and 50.9 ± 10.3 min (P < 0.01), respectively. There was no significant difference between the groups in serum creatinine values at 3 days after the operation (P > 0.05); however, the creatinine values at 3 days after the operation decreased significantly compared with those before the operation (P < 0.01). In the OPSG, there was no significant difference in creatinine values between 3 days and 6 months after operation, while the creatinine values 1 year after operation were increased significantly compared to those at 3 days after the operation (P < 0.05). In the MSG, there was no significant difference among creatinine values at different intervals (P > 0.05). The total rate of post-procedural complication was lower in the MSG than that in the OPSG(P < 0.05). There was no significant difference in the QOL score between the two groups before the operation (P > 0.05); however, the QOL scores at 6 months and 1 year after the operation were higher in the MSG than that in the OPSG(P < 0.05). In the MSG, there was no significant difference in the QOL score between preoperation and 6 months after surgery. Similarly, there was also no difference in the QOL score between 6 months after surgery and 1 year after surgery(P > 0.05). On the contrary, the differences of QOL score in the OPSG group were much significant between disparate time intervals (P < 0.05). CONCLUSIONS For patients with MUO who require long-term retention of the stent, metallic stents with longer indwelling time are superior to ordinary polymeric stents.
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Affiliation(s)
- Yue Chen
- Department of Urology, The Second Hospital of Tianjin Medical University, No.23, Pingjiang Road, Hexi Disctrict, Tianjin, 300211 China
| | - Cheng-yi Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, No.23, Pingjiang Road, Hexi Disctrict, Tianjin, 300211 China
| | - Zhi-hong Zhang
- Department of Urology, The Second Hospital of Tianjin Medical University, No.23, Pingjiang Road, Hexi Disctrict, Tianjin, 300211 China
| | - Peng-cheng Xu
- Department of Urology, Lu’an Affiliated Hospital of Anhui Medical University, Lu’an, 237000 Anhui China
| | - De-gang Chen
- Department of Urology, Lu’an Affiliated Hospital of Anhui Medical University, Lu’an, 237000 Anhui China
| | - Xin-huan Fan
- Department of Urology, Lu’an Affiliated Hospital of Anhui Medical University, Lu’an, 237000 Anhui China
| | - Ji-ci Ma
- Department of Urology, Lu’an Affiliated Hospital of Anhui Medical University, Lu’an, 237000 Anhui China
| | - Yi-peng Xu
- Institute of Urology, Zhejiang Cancer Hospital, Hangzhou, 310000 ZheJiang China
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Champagne S, Mostaed E, Safizadeh F, Ghali E, Vedani M, Hermawan H. In Vitro Degradation of Absorbable Zinc Alloys in Artificial Urine. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E295. [PMID: 30669269 PMCID: PMC6356898 DOI: 10.3390/ma12020295] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
Absorbable metals have potential for making in-demand rigid temporary stents for the treatment of urinary tract obstruction, where polymers have reached their limits. In this work, in vitro degradation behavior of absorbable zinc alloys in artificial urine was studied using electrochemical methods and advanced surface characterization techniques with a comparison to a magnesium alloy. The results showed that pure zinc and its alloys (Zn⁻0.5Mg, Zn⁻1Mg, Zn⁻0.5Al) exhibited slower corrosion than pure magnesium and an Mg⁻2Zn⁻1Mn alloy. The corrosion layer was composed mostly of hydroxide, carbonate, and phosphate, without calcium content for the zinc group. Among all tested metals, the Zn⁻0.5Al alloy exhibited a uniform corrosion layer with low affinity with the ions in artificial urine.
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Affiliation(s)
- Sébastien Champagne
- Department of Mining, Metallurgical and Materials Engineering, Laval University, 1065 avenue de la Médecine, Québec, QC G1V 0A6, Canada.
- Research Center of CHU de Québec, 10 rue de l'Espinay, Québec, QC G1L 3L5, Canada.
| | - Ehsan Mostaed
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa 1, 20156 Milan, Italy.
| | - Fariba Safizadeh
- Department of Mining, Metallurgical and Materials Engineering, Laval University, 1065 avenue de la Médecine, Québec, QC G1V 0A6, Canada.
| | - Edward Ghali
- Department of Mining, Metallurgical and Materials Engineering, Laval University, 1065 avenue de la Médecine, Québec, QC G1V 0A6, Canada.
| | - Maurizio Vedani
- Department of Mechanical Engineering, Politecnico di Milano, Via La Masa 1, 20156 Milan, Italy.
| | - Hendra Hermawan
- Department of Mining, Metallurgical and Materials Engineering, Laval University, 1065 avenue de la Médecine, Québec, QC G1V 0A6, Canada.
- Research Center of CHU de Québec, 10 rue de l'Espinay, Québec, QC G1L 3L5, Canada.
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Davis NF, Mulvihill JJ, Lynch JJ, Browne E, Bolton DM, Jack GS, Walsh MT. Digital and Mechanical Characterization of Ureteral Stent Luminal Reduction in Response to Extrinsic Compression Forces. J Endourol 2018; 32:1148-1153. [DOI: 10.1089/end.2018.0573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niall F. Davis
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - John J.E. Mulvihill
- Bernal Institute and the Health Research Institute, School of Engineering, University of Limerick, Limerick, Ireland
| | - James J. Lynch
- Bernal Institute and the Health Research Institute, School of Engineering, University of Limerick, Limerick, Ireland
| | - Eva Browne
- University Hospital Limerick, Limerick, Ireland
| | - Damien M. Bolton
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - Gregory S. Jack
- Department of Urology, The Austin Hospital, Melbourne, Australia
| | - Michael T. Walsh
- Bernal Institute and the Health Research Institute, School of Engineering, University of Limerick, Limerick, Ireland
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12
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Taguchi M, Inoue T, Muguruma K, Murota T, Kinoshita H, Matsuda T. Impact of loop-tail ureteral stents on ureteral stent-related symptoms immediately after ureteroscopic lithotripsy: Comparison with pigtail ureteral stents. Investig Clin Urol 2017; 58:440-446. [PMID: 29124244 PMCID: PMC5671964 DOI: 10.4111/icu.2017.58.6.440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/27/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate urination-related quality of life (QoL) in patients with an indwelling ureteral stent immediately after ureteroscopic lithotripsy (URSL) for upper urinary calculi. We compared the effects of loop-tail and pigtail ureteral stents on urination-related QoL. Materials and Methods Of 135 patients who underwent URSL between May 2014 and March 2015 at our hospital, we retrospectively analyzed the records of 70 patients (42 men, 28 women; median age, 63 years) in whom the stent tail was positioned inside the bladder without crossing the midline and who completed the core lower urinary tract symptoms score (CLSS) questionnaire pre- and postoperatively. Results There were significant differences in incomplete emptying (p=0.048) and bladder pain (p=0.041) between patients with loop-tail versus pigtail ureteral stents after URSL. In the multivariate analysis, stent type had a stronger association with incomplete emptying (p=0.022) and bladder pain (p=0.018) than age, sex, body mass index, stent side, operation time, diameter of ureteral access sheath, and stent type. Conclusions Patients with loop-tail ureteral stents had better urination-related QoL in the immediate post-URSL stage than patients with pigtail stents.
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Affiliation(s)
- Makoto Taguchi
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan.,Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Takaaki Inoue
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan
| | - Kouei Muguruma
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan
| | - Takashi Murota
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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13
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Mosayyebi A, Vijayakumar A, Yue QY, Bres-Niewada E, Manes C, Carugo D, Somani BK. Engineering solutions to ureteral stents: material, coating and design. Cent European J Urol 2017; 70:270-274. [PMID: 29104790 PMCID: PMC5656375 DOI: 10.5173/ceju.2017.1520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction An ideal stent would offer simple insertion and removal with no discomfort and/or migration, it would have no biofilm formation or encrustation and would also maintain the patient's quality of life. Material and methods In this mini-review, we outlined the engineering developments related to stent material, design and coating. Results There have been a wide variety of in-vitro, model-based, animal-based and clinical studies using a range of commercial and non-commercial stents. Ureteric stents have evolved since their first usage with a wider range of stent design, material and coating available for laboratory and clinical use. Conclusions While engineering innovations have led to the evolution of stents, more work needs to be done to address the issues relating to stent 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, United Kingdom.,Institute for Life Sciences (IFLS), University of Southampton, Southampton, United Kingdom
| | - Aravinthan Vijayakumar
- Bioengineering Science research group, Faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom
| | - Qi Y Yue
- Bioengineering Science research group, Faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom
| | | | - 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, United Kingdom.,Institute for Life Sciences (IFLS), University of Southampton, Southampton, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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14
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[Management of ureteral obstruction : Value of percutaneous nephrostomy and ureteral stents]. Urologe A 2016; 55:1497-1510. [PMID: 27787581 DOI: 10.1007/s00120-016-0253-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ureteral obstruction represents a heterogeneous disease pattern and is treated by ureteral stenting or percutaneous nephrostomy (PCN) depending on the necessity. The benefits of urinary diversion with ureteral stenting or PCN in malignant ureteral obstruction (MUO) for patient survival are only moderate. No differences have been found between ureteral stenting and PCN in MUO with regard to median patient survival and complication rates. In cases of MUO there is currently no evidence that urinary diversion improves the quality of life. Alternative concepts of ureteral stenting, such as tandem ureteral stents, metallic ureteral stents or metal mesh ureteral stents have not yet shown clear benefits. In benign ureteral obstruction, prospective randomized studies have demonstrated comparable quality of life after PCN or ureteral stenting. The method of choice for urinary diversion is influenced by the recommendations, personal experience of the clinician and the availability of the method.
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15
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Elsamra SE, Leavitt DA, Motato HA, Friedlander JI, Siev M, Keheila M, Hoenig DM, Smith AD, Okeke Z. Stenting for malignant ureteral obstruction: Tandem, metal or metal-mesh stents. Int J Urol 2015; 22:629-36. [PMID: 25950837 DOI: 10.1111/iju.12795] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/04/2015] [Accepted: 03/22/2015] [Indexed: 12/11/2022]
Abstract
Extrinsic malignant compression of the ureter is not uncommon, often refractory to decompression with conventional polymeric ureteral stents, and frequently associated with limited survival. Alternative options for decompression include tandem ureteral stents, metallic stents and metal-mesh stents, though the preferred method remains controversial. We reviewed and updated our outcomes with tandem ureteral stents for malignant ureteral obstruction, and carried out a PubMed search using the terms "malignant ureteral obstruction," "tandem ureteral stents," "ipsilateral ureteral stents," "metal ureteral stent," "resonance stent," "silhouette stent" and "metal mesh stent." A comprehensive review of the literature and summary of outcomes is provided. The majority of studies encountered were retrospective with small sample sizes. The evidence is most robust for metal stents, whereas only limited data exists for tandem or metal-mesh stents. Metal and metal-mesh stents are considerably more expensive than tandem stenting, but the potential for less frequent stent exchanges makes them possibly cost-effective over time. Urinary tract infections have been associated with all stent types. A wide range of failure rates has been published for all types of stents, limiting direct comparison. Metal and metal-mesh stents show a high incidence of stent colic, migration and encrustation, whereas tandem stents appear to produce symptoms equivalent to single stents. Comparison is difficult given the limited evidence and heterogeneity of patients with malignant ureteral obstruction. It is clear that prospective, randomized studies are necessary to effectively scrutinize conventional, tandem, metallic ureteral and metal-mesh stents for their use in malignant ureteral obstruction.
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Affiliation(s)
- Sammy E Elsamra
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - David A Leavitt
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Hector A Motato
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Justin I Friedlander
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Michael Siev
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Mohamed Keheila
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - David M Hoenig
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Arthur D Smith
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Zeph Okeke
- The Smith Institute for Urology, Hofstra-North Shore-LIJ Health System, New Hyde Park, New York, USA
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16
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Kallidonis PS, Georgiopoulos IS, Kyriazis ID, Kontogiannis S, Al-Aown AM, Liatsikos EN. The full metallic double-pigtail ureteral stent: Review of the clinical outcome and current status. Indian J Urol 2015; 31:8-14. [PMID: 25624569 PMCID: PMC4300582 DOI: 10.4103/0970-1591.134232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The full metallic double-J ureteral stent (MS) was introduced as a method for providing long-term drainage in malignant ureteral obstruction. Experimental evaluation of the MS revealed that its mechanical features allow efficient drainage in difficult cases, which could not be managed by the insertion of a standard polymeric double-J stent. Clinical experience with the MS showed controversial results. Careful patient selection results in efficient long-term management of malignant ureteral obstruction. The use of the MS should also be considered in selected benign cases. Major complications are uncommon and the minor complications should not hinder its use. Experience in pediatric patients is limited and warrants additional study. The cost-effectiveness of the MS seems to be appropriate for long-term treatment. Further investigation with comparative clinical trials would document the outcome more extensively and establish the indications as well as the selection criteria for the MS.
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Affiliation(s)
| | | | - Iason D Kyriazis
- Department of Urology, University of Patras, Rion, Patras, Greece
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17
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Zou T, Wang L, Li W, Wang W, Chen F, King MW. A resorbable bicomponent braided ureteral stent with improved mechanical performance. J Mech Behav Biomed Mater 2014; 38:17-25. [DOI: 10.1016/j.jmbbm.2014.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 06/05/2014] [Accepted: 06/08/2014] [Indexed: 11/30/2022]
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18
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Abdulmajed MI, Jones VW, Shergill IS. The first use of Resonance(®) metallic ureteric stent in a case of obstructed transplant kidney. Int J Surg Case Rep 2014; 5:375-7. [PMID: 24858983 DOI: 10.1016/j.ijscr.2014.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/24/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION To date, double JJ stent is the mainstay ureteric stent used in a transplant kidney. We herein report the first use of Resonance(®) metallic ureteric stent to manage ureteric obstruction in a transplant kidney. PRESENTATION OF CASE A 45-year-old lady underwent an uneventful living related donor renal transplantation. Due to post-operative pelvi-ureteric obstruction and recurrent obstruction following multiple distal stent migration and expulsion necessitated frequent nephrostomy insertion and antegrade stenting, she underwent challenging but successful retrograde insertion of a 12 centimetres long and size 6.0 French Cook Resonance(®) metallic ureteric stent which was performed under general anaesthesia. DISCUSSION Metallic ureteric stents are a fairly recent introduction to modern urology and they have been successfully used in the management of benign and malignant obstruction of ureter. CONCLUSION This is the first case of therapeutic metallic ureteric stent insertion in a transplant kidney.
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19
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Polcari AJ, Hugen CM, López-Huertas HL, Turk TMT. Cost analysis and clinical applicability of the Resonance®metallic ureteral stent. Expert Rev Pharmacoecon Outcomes Res 2014; 10:11-5. [PMID: 20121560 DOI: 10.1586/erp.09.74] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Anthony J Polcari
- Loyola University Medical Center, Department of Urology, Building 54, Room 200, Maywood, IL 60153, USA
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20
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Abbasi A, Wyre HW, Ogan K. Use of full-length metallic stents in malignant ureteral obstruction. J Endourol 2013; 27:640-5. [PMID: 23237309 DOI: 10.1089/end.2012.0448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Malignant ureteral obstruction (MUO) has traditionally been a difficult problem to manage. Indwelling ureteral stents have a failure rate up to 50%, necessitating the placement of percutaneous nephrostomy (PCN) drainage, which has associated complications and impacts on quality of life. Recently, metallic ureteral stents have emerged as a treatment for extrinsic ureteral obstruction. We present our initial experience using Resonance (Cook Urologic, Spencer, IN) full-length metallic stents for MUO. MATERIALS AND METHODS 20 patients (27 renal units) with advanced cancers and MUO were treated with metallic stents. Patients were followed prospectively to evaluate for recurrent obstruction. Perioperative morbidity and overall mortality were recorded. RESULTS The mean patient age was 49.9 years (SD 18.9). The primary malignancies causing MUO were gastrointestinal (8), gynecologic (6), genitourinary (2), or other (4). All but two renal units had been previously treated with traditional stents. Eight out of 20 (40%) patients required further intervention for their MUO. Mean time to failure for the metallic stents was 7.4 months (222 days). Two patients required conversion to percutaneous drainage. Five patients required change to traditional stents (3) or removal of metallic stents. At the last follow-up, sixteen patients had died. Fourteen of the sixteen patients died with functioning metallic stents in place, although one patient who initially had bilateral metallic stent placements had a left stent removed due to migration. Of the remaining four living patients, two have functioning metallic stents at a mean follow-up of 42 months. DISCUSSION MUO remains a difficult clinical problem in a group of patients with a high mortality. While metallic stents ultimately have a failure rate similar to that of traditional stents, the mean time to failure is longer. Therefore, metallic stents may benefit patients with MUO, because the longer dwell time may eliminate the need for more frequent stent changes or further interventions.
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Affiliation(s)
- Ammara Abbasi
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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21
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22
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Kawahara T, Ito H, Terao H, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Changing to a loop-type ureteral stent decreases patients' stent-related symptoms. ACTA ACUST UNITED AC 2012; 40:763-7. [PMID: 22899382 DOI: 10.1007/s00240-012-0500-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 08/02/2012] [Indexed: 11/29/2022]
Abstract
The first indwelling ureteral splint was described in 1967. A ureteral stent can cause unpleasant side effects, such as urinary frequency, urgency, incontinence, hematuria, bladder pain and flank pain, which have a negative impact on a patient's quality of life. It is necessary to minimize the amount of material in the bladder in order to decrease stent-related symptoms. This study investigated the stent-related symptoms after changing from a double pigtail to a loop-type ureteral stent in the same patient group. This study followed 25 patients who underwent ureteral stent exchange from double pigtail to loop-type ureteral stent between September 2009 and February 2010. Ureteral stents were exchanged using topical, conscious sedation and general anesthesia for the various procedures including stent exchange, before/after shock wave lithotripsy and before/after ureteroscopy. The stent length was selected to be the same as whole ureteral length and the caliber based on the previous stent. A self-administered stent-related symptom questionnaire was used to assess stent-related symptoms in comparison to the previous double-pigtail stents. A total of 25 patients with a median age of 56.5 years underwent ureteral stent exchange. All patients had stone disease except two patients who had ureteral stricture. Almost all of stent-related symptoms without nocturia showed a significantly lower score with the loop-type ureteral stent than in double-pigtail stent. None of the patients experienced urinary tract infection either before or after undergoing ureteral stent exchange. Changing to loop-type ureteral stent significantly decreased ureteral stent-related symptoms.
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Affiliation(s)
- Takashi Kawahara
- Department of Urology, Ohguchi Higashi General Hospital, 2-19-1, Irie, Kanagawa-ku, Yokohama, Kanagawa, Japan
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Kawahara T, Ito H, Terao H, Yoshida M, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Which is the best method to estimate the actual ureteral length in patients undergoing ureteral stent placement? Int J Urol 2012; 19:634-8. [PMID: 22435420 DOI: 10.1111/j.1442-2042.2012.02998.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To define the best modality for estimating ureteral length in patients undergoing ureteral stent placement. METHODS This study enrolled 151 patients (169 ureters) undergoing stent insertion. In all of them, an intravenous urography and non-contrast computed tomography were carried out. The actual ureteral length was determined by direct measurement using a 5-Fr ureteral catheter. A multivariate analysis evaluated the association between the ureteral length and each of the following parameters: body height, body surface area, ureteral trace by intravenous urography, linear distance (liner distance 1) from the ureteropelvic junction to the ureterovesical junction by intravenous urography, linear distance (liner distance 2) from the mid kidney to the ureterovesical junction by intravenous urography, and the distance from the level of the renal vein to the ureterovesical junction by axial computed tomography (axial computed tomography distance). RESULTS The mean actual ureteral length was 23.2 cm (median 24 cm, range 16-29 cm). The Spearman correlation coefficients for body height, body surface area, ureteral trace, liner distance 1, liner distance 2 and axial computed tomography distance were 0.3126, 0.3076, 0.4541, 0.5230, 0.4796 and 0.6168, respectively. Axial computed tomography distance showed the best correlation with the actual ureteral length. CONCLUSION The axial computed tomography distance as calculated by the axial computed tomography can more reliably predict the actual ureteral length than other parameters. Further studies are required to show the best method for estimating the actual ureteral length in patients undergoing ureteral stent placement.
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Affiliation(s)
- Takashi Kawahara
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
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Kawahara T, Ito H, Terao H, Yoshida M, Ogawa T, Uemura H, Kubota Y, Matsuzaki J. Choosing an appropriate length of loop type ureteral stent using direct ureteral length measurement. Urol Int 2011; 88:48-53. [PMID: 22104688 DOI: 10.1159/000332431] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 08/30/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE The ureteral stent is now a fundamental part of many urological procedures. To decrease ureteral stent-related symptoms, loop type ureteral stent was developed. However the most important factor to decrease urinary symptoms is choosing the optimal length of a ureteral stent. We investigated the relationship between the actual ureteral length and the loop type ureteral stent position. MATERIALS AND METHODS A total of 226 loop type polyurethane ureteral stents (156 patients) were inserted with four options for stent length (20, 22, 24 and 26 cm). The ureteral length was measured using a ruled 5-Fr ureteral catheter. The appropriateness of stent position was defined into three groups based on kidney-ureter-bladder films. RESULTS Nine stents (3.9%) migrated, 171 stents (75.7%) were in the appropriate position and 46 stents (19.5%) were overlong. The rate of migration rate and overlong stents closely correlated with the ureteral length when the proximal end of the stent was in the renal pelvis. CONCLUSIONS It is appropriate to choose a loop type ureteral stent that is the same or 1 cm less than the length of the ureter when the proximal end of the stent will be in the renal pelvis.
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Affiliation(s)
- Takashi Kawahara
- Department of Urology, Ohguchi Higashi General Hospita, Yokohama, Japan. takashi_tk2001 @ yahoo.co.jp
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25
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Abstract
Ureteral stents are commonly used in urology but are frequently associated with patient discomfort, stent encrustation and stent-related infection. New biomaterials, coatings and designs have been designed to attempt to reduce these problems. This article reviews coatings to reduce bacterial adhesion and encrustation. In addition, metal ureteral stents, the triclosan and ketorolac drug eluting ureteral stents, and biodegradable ureteral stents are discussed. In summary there is no perfect ureteral stent that avoids all morbidity but there have been significant advances in the last few years in stent technology.
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Affiliation(s)
- Dirk Lange
- University of British Columbia, Vancouver, BC, Canada
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26
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Al-Aown A, Kyriazis I, Kallidonis P, Kraniotis P, Rigopoulos C, Karnabatidis D, Petsas T, Liatsikos E. Ureteral stents: new ideas, new designs. Ther Adv Urol 2011; 2:85-92. [PMID: 21789086 DOI: 10.1177/1756287210370699] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ureteral stents represent a minimally invasive alternative to preserve urinary drainage whenever ureteral patency is deteriorated or is under a significant risk to be occluded due to extrinsic or intrinsic etiologies. The ideal stent that would combine perfect long-term efficacy with no stent-related morbidity is still lacking and stent usage is associated with several adverse effects that limit its value as a tool for long-term urinary drainage. Several new ideas on stent design, composition material and stent coating currently under evaluation, foreseen to eliminate the aforementioned drawbacks of ureteral stent usage. In this article we review the currently applied novel ideas and new designs of ureteral stents. Moreover, we evaluate potential future prospects of ureteral stent development adopted mostly by the pioneering cardiovascular stent industry, focusing, however, on the differences between ureteral and endothelial tissue.
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Hendlin K, Korman E, Monga M. New metallic ureteral stents: improved tensile strength and resistance to extrinsic compression. J Endourol 2011; 26:271-4. [PMID: 22011000 DOI: 10.1089/end.2011.0332] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Extrinsic ureteral compression challenges a ureteral stent's ability to facilitate urinary drainage and to protect the kidney. Our purpose was to evaluate the performance of new metallic coil-based ureteral stents in terms of tensile strength and radial compression force. MATERIALS AND METHODS Three stent designs tested from Prosurg Inc included Passage 7.0F, Snake 6.0F, and Snake 7.0F with the straight section covered with a biocompatible polymer tubing. A MTS Microbionix Testing System using Testworks II software, vibration isolation table, and a 5-N load cell were used to measure tensile and compressive strength. Stents were placed in hydraulic grips and stretched at a rate of 5 mm/s for 1 second under uniaxial tension. Extrinsic compression was exerted in 0.1-mm increments to maximum compression. The Young Modulus, E, was calculated from each trial using engineering stress. Data were analyzed using Mann-Whitney and t tests. RESULTS The Passage, Snake 6F, and Snake 7F stents had tensile strengths of 27±3, 5±0.1, and 73±26 kPa, respectively. Mann-Whitney tests show statistically significant difference between stents (P<0.05). Elastic modulus needed to cause extrinsic compression was highest for Snake 6F (145,842±14332 Pa) compared with that of Passage (124,999±3182 Pa) and Snake 7F (126,132±19316 Pa), (P<0.05). CONCLUSION The Snake 6F stent had the lowest tensile strength and was least resistant to extrinsic compression. The Snake 7F had the highest tensile strength and was most resistant to extrinsic compression. All three stents are more resistant to extrinsic compression than the Applied Silhouette or Cook Resonance, yet have lower tensile strengths.
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Affiliation(s)
- Kari Hendlin
- Department of Urologic Surgery, University of Minnesota, Minneapolis, MN, USA.
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Affiliation(s)
- Daniel Yachia
- Department of Urology. Hillel Yaffe Medical Center, Hadera - Israel, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa - Israel. E-mail:
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29
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Benson AD, Taylor ER, Schwartz BF. Metal ureteral stent for benign and malignant ureteral obstruction. J Urol 2011; 185:2217-22. [PMID: 21497845 DOI: 10.1016/j.juro.2011.02.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Indexed: 02/08/2023]
Abstract
PURPOSE Metal ureteral stents are a relatively new version of a device with a long history of relieving ureteral obstruction. Metal stents are effective for relieving ureteral obstruction but success regarding patient tolerability has been variable. We present our single institution experience with long-term metal ureteral stent placement. MATERIALS AND METHODS The charts of patients undergoing metal ureteral stent placement for chronic ureteral obstruction were reviewed. Data collected included patient age, gender, diagnosis/cause of obstruction, laterality, duration of indwelling metal stent, number of routine metal stent changes, complications and early discontinuations or stent changes. RESULTS A total of 23 patients underwent placement of metal ureteral stents between February 2008 and September 2010. Bilateral stents were placed in 5 patients and 9 underwent a yearly metal stent exchange for a total of 42 ureteral units treated with metal ureteral stents. All metal stents were placed to relieve ureteral obstruction due to ureteral stricture, ureteropelvic junction obstruction, retroperitoneal fibrosis or extrinsic malignant obstruction. There were 3 metal stent failures in 2 patients with malignant ureteral obstruction. There were no complications, or early discontinuations or changes due to adverse symptoms, patient dissatisfaction, worsening renal function or progressive hydronephrosis. CONCLUSIONS Metal ureteral stents are effective for benign and malignant ureteral obstruction in the absence of urolithiasis. Good tolerability and annual stent exchange make metal stents an appealing alternative for patients with chronic ureteral obstruction treated with indwelling ureteral stents.
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Affiliation(s)
- Aaron D Benson
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9665, USA
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Rao MV, Polcari AJ, Turk TM. Updates on the use of ureteral stents: focus on the Resonance(®) stent. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2011; 4:11-5. [PMID: 22915925 PMCID: PMC3417869 DOI: 10.2147/mder.s11744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Resonance(®) metallic ureteral stent is one of the latest additions to the urologist's armamentarium in managing ureteral obstruction. One advantage of this stent over traditional polymer-based stents is resistance to encrustation with stone material, which allows longer dwell times and less frequent exchange procedures. Although exchanging a metallic stent is slightly more complicated than exchanging a polymer stent, the fluoroscopic techniques required are familiar to most urologists. The Resonance stent is also more resistant to compression by external forces, potentially allowing greater applicability in patients with metastatic cancer. Furthermore, the use of this stent in patients with benign ureteral obstruction is shown to be associated with significant cost reduction. Clinical studies on the use of this stent are accumulating and the results are mixed, although Level 1 evidence is lacking. In this article we present a comprehensive review of the available literature on the Resonance metallic ureteral stent.
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Affiliation(s)
- Manoj V Rao
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
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Wang HJ, Lee TY, Luo HL, Chen CH, Shen YC, Chuang YC, Chiang PH. Application of resonance metallic stents for ureteral obstruction. BJU Int 2010; 108:428-32. [DOI: 10.1111/j.1464-410x.2010.09842.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Miyaoka R, Hendlin K, Monga M. Resistance to Extrinsic Compression and Maintenance of Intraluminal Flow in Coil-Reinforced Stents (Silhouette® Scaffold Device): An In Vitro Study. J Endourol 2010; 24:595-8. [DOI: 10.1089/end.2009.0513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ricardo Miyaoka
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Kari Hendlin
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Manoj Monga
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
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Sountoulides P, Pardalidis N, Sofikitis N. Endourologic management of malignant ureteral obstruction: indications, results, and quality-of-life issues. J Endourol 2010; 24:129-42. [PMID: 19954354 DOI: 10.1089/end.2009.0157] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Obstruction of the upper urinary tract is a problem commonly faced by practicing urologists. The constant evolution in endourology has effectively facilitated minimally invasive management of upper-tract obstruction. In a case in which malignancy is the cause of obstruction, however, the situation significantly changes. Questions arise regarding the need for relieving the obstruction, the means to accomplish this, and the benefits and drawbacks of each technique regarding both their efficacy and their impact on the patients well-being and the crucial issue of quality of life in the face of malignancy.
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Ureteral Obstruction: Is the Full Metallic Double-Pigtail Stent the Way to Go? Eur Urol 2010; 57:480-6. [PMID: 19232816 DOI: 10.1016/j.eururo.2009.02.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 02/02/2009] [Indexed: 11/22/2022]
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Christman MS, L’Esperance JO, Choe CH, Stroup SP, Auge BK. Analysis of ureteric stent kinking forces: the role of curvature in stent failure. BJU Int 2010; 105:866-9; discussion 868-9. [DOI: 10.1111/j.1464-410x.2009.08833.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chew BH, Lange D. Ureteral stent symptoms and associated infections: a biomaterials perspective. Nat Rev Urol 2009; 6:440-8. [PMID: 19597512 DOI: 10.1038/nrurol.2009.124] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ureteral stents are commonly used in the field of urology, and, given their indwelling nature, are often a nidus for infection and a cause of discomfort. To minimize symptoms, the urologic surgeon should first consider whether a stent needs to be placed at all. Softer stents do not seem to improve patient comfort. Stents that are too long, specifically those that cross the midline of the bladder, significantly increase the frequency of stent-related symptoms. Administering alpha blockers while the stent is indwelling can reduce these symptoms. Antibiotic prophylaxis or concomitant antibiotic administration does not seem to reduce the incidence of stent-related urinary tract infection. At present, drug-eluting stents have shown the most promise for inhibiting bacterial adhesion and biofilm formation. Future stent designs that maintain drainage of the kidney and ureter while minimizing inflammation and contact with the urothelium will improve patient outcomes. By better understanding the basic pathways of bacterial adhesion to biomaterials, new stents and medications that target these mechanisms can be developed to eliminate bacterial adhesion and infection in patients with ureteral stents.
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Affiliation(s)
- Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
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Meria P. Editorial comment on: Ureteral obstruction: is the full metallic double-pigtail stent the way to go? Eur Urol 2009; 57:487. [PMID: 19232818 DOI: 10.1016/j.eururo.2009.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Analysis of ureteral stent compression force and its role in malignant obstruction. J Urol 2008; 181:392-6. [PMID: 19010490 DOI: 10.1016/j.juro.2008.08.125] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Indexed: 01/28/2023]
Abstract
PURPOSE Extrinsic ureteral obstruction can be a challenging entity for the urologist since half of the ureteral stents placed for malignant obstruction fail. We evaluated the resistance to radial compression of various stents. MATERIALS AND METHODS Silhouette(R) 4.6Fr, 6Fr and 8Fr, Sof-Curl Tecoflex 6Fr, Resonance 6Fr, Polaris Ultra 6Fr and 7Fr, and Percuflex 6Fr and 8Fr stents were tested. The force needed to compress the stent to 50% of its original external diameter was measured at 3 locations along the stent length, including proximal, middle and distal. Statistical analysis was performed. RESULTS Statistically greater force was required to compress the Resonance and Silhouette stents compared to all others tested. These results were maintained at all 3 locations along the stent. Only the Polaris 6Fr stent differed in resistance to compression along the stent length. CONCLUSIONS The significantly higher forces required to compress the Resonance and Silhouette stents may translate into improved success in patients with malignant ureteral obstruction.
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