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Awonusi BO, Li H, Yin Z, Zhao J, Yang K, Li J. Surface Modification of Zn-Cu Alloy with Heparin Nanoparticles for Urinary Implant Applications. ACS APPLIED BIO MATERIALS 2024; 7:1748-1762. [PMID: 38428026 DOI: 10.1021/acsabm.3c01177] [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] [Indexed: 03/03/2024]
Abstract
In this work, an investigation on the Zn-Cu alloy coated with heparin was conducted in order to explore the potentiality of its application as a feasible alternative for biodegradable implants, with the specific goal of addressing the issue of encrustation in the urinary system. The stability of the nanoparticles were characterized by dynamic light scattering. Typical surface characterization such as X-ray photoelectron spectroscopy, scanning electron microscopy, and atomic force microscopy were used to demonstrate a successful immobilization of the NPs. The in vitro corrosion behavior was studied by potentiodynamic polarization and immersion tests in artificial urine (AU) at 37 °C. The 8 weeks in vivo degradation, encrustation resistance, hemocompatibility, and histocompatibility were investigated by means of implantation into the bladders of rats. Both in vitro and in vivo degradation tests exhibited a higher degradation rate for Zn-Cu and NPs groups when compared to pure Zn. Histological evaluations and hemocompatibility revealed that there was no tissue damage or pathological alterations caused by the degradation process. Furthermore, antiencrustation performance and urinalysis results confirmed that the modified alloy demonstrated significant encrustation inhibitory properties and bactericidal activity compared to the pure Zn control. Our findings highlight the potential of this modified alloy as an antiencrustation biodegradable ureteral stent.
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Affiliation(s)
- Bukola O Awonusi
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Hongwei Li
- Department of Urology, General Hospital of Northern Theater Command, Shenyang 110840, China
| | - Zecheng Yin
- Institute of Information and Control Engineering, Shenyang Urban Construction University, Shenyang 110167, China
| | - Jing Zhao
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Jianzhong Li
- Department of Urology, General Hospital of Northern Theater Command, Shenyang 110840, China
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Allam CL, Aden JK, Reed AM. The Role of Routine Ureteral Stenting Following Uncomplicated Ureteroscopic Treatment for Upper Ureteral and Renal Stones: A Randomized Control Trial. J Endourol 2023; 37:257-263. [PMID: 36401514 DOI: 10.1089/end.2022.0386] [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] [Indexed: 11/21/2022] Open
Abstract
Purpose: Ureteral stenting following uncomplicated ureteroscopy (URS) is common practice. Several studies have proven the safety of omitting routine stent placement following distal ureteral stone treatment. However, there is a paucity of data regarding the utility of stent placement for proximal URS. We designed a prospective, randomized controlled trial to evaluate the role of ureteral stent placement following URS for proximal ureteral and renal stones. Methods: Seventy-two patients with proximal ureteral or renal stones measuring as much as 1.5 cm were prospectively randomized into stented (37) or unstented (35) groups. The surgeon was blinded to the treatment group until after stone treatment. Patients tracked postoperative pain medications and completed validated pain questionnaires on postoperative days 0, 3, 7, and 28. Stents were removed on postoperative day 7. Postoperative follow-up imaging was obtained at 4 weeks. Results: No statistical differences were observed between the two groups in terms of demographics or stone characteristics. The operative time was longer in the stented group (p < 0.03). Patients in the stented group had more irritative urinary symptoms (p < 0.0001) and pain (p < 0.0001), missed more days of work (p < 0.01), and used more narcotics (p < 0.0005) during the first week, but no differences were observed at 30 days. Emergency room visits and overall complication rates were similar between the two groups. Three nonstented patients required stent placement. Two stented patients required early stent removal. Urinary tract infections developed in three stented patients, but not in unstented patients. Postoperative imaging did not reveal any hydronephrosis in either group, and the total stone-free rate was 94%. Conclusions: For most patients undergoing uncomplicated ureteroscopic treatment for proximal ureteral and kidney stones, it may be safe to omit ureteral stents to potentially decrease urinary symptoms and pain while improving short-term quality of life. Further studies with larger patient cohorts may be warranted to confirm our results.
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Affiliation(s)
- Christopher L Allam
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - James K Aden
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Amy M Reed
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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Li Y, Jiang L, Luo S, Hu D, Zhao X, Zhao G, Tang W, Guo Y. Analysis of Characteristics, Pathogens and Drug Resistance of Urinary Tract Infection Associated with Long-Term Indwelling Double-J Stent. Infect Drug Resist 2023; 16:2089-2096. [PMID: 37063938 PMCID: PMC10094401 DOI: 10.2147/idr.s392857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/21/2023] [Indexed: 04/18/2023] Open
Abstract
Objective To investigate the characteristics, pathogens and drug resistance of urinary tract infection (UTI) associated with long-term indwelling double-J stent. Methods The clinical data of 102 patients with urinary tract infection associated with long-term indwelling double-J stent in University-Town Hospital of Chongqing Medical University and Chongqing Traditional Chinese Medicine Hospital from September 2010 to July 2022 were collected retrospectively, and the difference between etiological characteristics were analyzed. Urine and double-J stent samples of patients were collected for pathogen identification and drug sensitivity test. Results A total of 102 patients, 39 (38.23%) males and 63 (61.77%) females, aged 24-72 years, with a median age of 48 years, were included in this study. Urinary calculi (40.20%) and ureteral stricture (24.50%) were the main causes of urinary tract infection associated with long-term indwelling double-J stent. Among the patients with urinary tract infection caused by double-J stent, female patients were higher than male patients (61.77% vs 38.23%). In terms of positive rate of pathogenic bacteria culture, the rate of double-J stent was higher than that of urine (67.65% vs 35.29%). The main pathogenic bacteria in urine were Escherichia coli (30.55%) of Gram negative bacteria, while the main pathogenic bacteria in double-J stent were enterococcus faecalis (27.53%) of Gram positive bacteria. The resistance rate of Gram positive bacteria in double-J stent to vancomycin, ciprofloxacin, meropenem and piperacillin/tazobactam was significantly higher than that in urine (P<0.05). The resistance rate of Gram negative bacteria in double-J stent to imipenem, cefepime, piperacillin/tazobactam, meropenem and cefoperazone/sulbactam was significantly higher than that in urine (P<0.05). Conclusion Double-J stent associated urinary tract infection is more common in women than in men. Escherichia coli and Enterococcus faecalis are the main pathogens, and the pathogens show strong drug resistance.
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Affiliation(s)
- Yuehua Li
- Department of Urology, University-Town Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Li Jiang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Shengjun Luo
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Daixing Hu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Xin Zhao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Guozhi Zhao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Wei Tang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, People’s Republic of China
| | - Yu Guo
- Department of Urology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400000, People’s Republic of China
- Correspondence: Yu Guo, Department of Urology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400000, People’s Republic of China, Tel/Fax +8623 67665886, Email
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Kram W, Rebl H, de la Cruz JE, Haag A, Renner J, Epting T, Springer A, Soria F, Wienecke M, Hakenberg OW. Interactive Effects of Copper-Doped Urological Implants with Tissue in the Urinary Tract for the Inhibition of Cell Adhesion and Encrustation in the Animal Model Rat. Polymers (Basel) 2022; 14:polym14163324. [PMID: 36015581 PMCID: PMC9412396 DOI: 10.3390/polym14163324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
The insertion of a ureteral stent provides acute care by restoring urine flow and alleviating urinary retention or dysfunction. The problems of encrustation, bacterial colonization and biofilm formation become increasingly important when ureteral stents are left in place for a longer period of time. One way to reduce encrustation and bacterial adherence is to modify the stent surface with a diamond-like carbon coating, in combination with copper doping. The biocompatibilities of the Elastollan® base material and the a-C:H/Cu-mulitilayer coating were tested in synthetic urine. The copper content in bladder tissue was determined by atomic absorption spectroscopy and in blood and in urine by inductively coupled plasma mass spectrometry. Encrustations on the materials were analyzed by scanning electron microscopy, energy dispersive X-ray spectroscopy and Fourier transform infrared spectroscopy. A therapeutic window for copper ions of 0.5–1.0 mM was determined to kill bacteria without affecting human urothelial cells. In the rat animal model, it was found that copper release did not reach toxic concentrations in the affecting tissue of the urinary tract or in the blood. The encrustation behavior of the surfaces showed that the roughness of the amorphous carbon layer with the copper doping is probably the causal factor for the higher encrustation.
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Affiliation(s)
- Wolfgang Kram
- Department of Urology, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany
- Correspondence:
| | - Henrike Rebl
- Department of Cell Biology, Rostock University Medical Center, Schillingallee 69, 18057 Rostock, Germany
| | - Julia E. de la Cruz
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, Km. 41.8, 10071 Cáceres, Spain
| | - Antonia Haag
- Department of Urology, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany
| | - Jürgen Renner
- Institute for Polymer- and Production Technologies e. V., Alter Holzhafen 19, 23966 Wismar, Germany
| | - Thomas Epting
- Institute for Clinical Chemistry and Laboratory Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetterstraße 55, 79106 Freiburg, Germany
| | - Armin Springer
- Electron Microscopy Center, Rostock University Medical Center, Strempelstraße 14, 18057 Rostock, Germany
| | - Federico Soria
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, Km. 41.8, 10071 Cáceres, Spain
| | | | - Oliver W. Hakenberg
- Department of Urology, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany
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Zeng K, Zhang JM, Li XB, Peng SX, Zhang SC, Xie WX, Xi CF, Cao CJ. Analysis of Bacterial Biofilm Formation in Patients with Malignancy Undergoing Double J Stent Indwelling and Its Influencing Factors. Infect Drug Resist 2021; 14:5209-5217. [PMID: 34916809 PMCID: PMC8666721 DOI: 10.2147/idr.s333421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze the bacterial biofilm (BF) formation in patients with malignancy undergoing double J stent indwelling and its influencing factors. Methods A total of 167 patients with malignant tumors who received double J stent indwelling in the hospital from January 2018 to January 2021 were included in the study. The urine and double J stent samples were collected for bacterial identification and observed for BF formation on the surface of the urinary catheter under a scanning electron microscope (SEM). Univariate and multivariate logistic regression analyses were used to analyze the influencing factors of BF. Results The BF formation rate was 34.73% (58/167). The BF formation rate of positive specimens cultured in urine and double J stent was significantly higher than that of negative ones (P<0.05). Staphylococcus was the main BF bacteria in double J stent and urine culture specimens, followed by Enterococcus, Pseudomonas, Enterobacter, and Acinetobacter. Compared with the non-BF group, the number of viable bacteria in the double J stent and urine and the catheterization time in the BF group rose markedly (P<0.05). Advanced age, chemotherapy, anemia, indwelling time ≥90d, and urinary tract infection were risk factors for BF formation in patients with malignancy undergoing double J stent indwelling (P<0.05). Conclusion There is a high rate of BF formation in patients with malignancy undergoing double J stent indwelling, with Staphylococcus as the dominant species. Treatment requires enhanced urinary catheter management and nutritional status to inhibit BF formation and lower the rate of urinary catheter-related infections.
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Affiliation(s)
- Ke Zeng
- Department of Urology, First People's Hospital of Zigong City, Zigong, People's Republic of China
| | - Jia-Mo Zhang
- Department of Urology, YongChuan Hospital Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiao-Bin Li
- Department of Urology, First People's Hospital of Zigong City, Zigong, People's Republic of China
| | - Sheng-Xian Peng
- Scientific Research Department, First People's Hospital of Zigong City, Zigong, People's Republic of China
| | - Su-Chuan Zhang
- Laboratory Department, First People's Hospital of Zigong City, Zigong, People's Republic of China
| | - Wen-Xian Xie
- Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, People's Republic of China
| | - Chun-Fang Xi
- Department of Urology, First People's Hospital of Zigong City, Zigong, People's Republic of China
| | - Cheng-Jian Cao
- Zigong Academy of Medical Sciences, First People's Hospital of Zigong City, Zigong, People's Republic of China
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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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Tie D, Hort N, Chen M, Guan R, Ulasevich S, Skorb EV, Zhao D, Liu Y, Holt-Torres P, Liu H. In vivo urinary compatibility of Mg-Sr-Ag alloy in swine model. Bioact Mater 2021; 7:254-262. [PMID: 34466731 PMCID: PMC8379362 DOI: 10.1016/j.bioactmat.2021.05.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 12/29/2022] Open
Abstract
A biodegradable metallic ureteral stent with suitable mechanical properties and antibacterial activity remains a challenge. Here we reveal the scientific significance of a biodegradable Mg-Sr-Ag alloy with a favorable combination of balanced mechanical properties, adjustable indwelling time in urinary tract and evident antibacterial activity via in vivo experiments in a swine model. Attributed to the rheo-solidification process, equiaxial microstructure and significantly refined grains (average grain size: 27.1 μm) were achieved. Mg17Sr2 and Mg4Ag were found as the primary precipitates in the matrix, due to which the alloy obtained ca. 111% increase in ultimate tensile strength in comparison to pure magnesium. Both the in vitro and in vivo results demonstrated the satisfactory biocompatibility of the alloy. Histological evaluation and bioindicators analysis suggested that there was no tissue damage, inflammation and lesions in the urinary system caused by the degradation process. The stent also improved the post-operative bladder functions viewed from the urodynamic results. Our findings highlight the potential of this alloy as antibacterial biodegradable urinary implant material. Innovative biodegradable antibacterial Mg-Sr-Ag alloy. In vivo study in pig ureter models. Enhanced mechanical properties and adjustable indwelling time. Outstanding urinary compatibility and evident antibacterial activity.
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Affiliation(s)
- Di Tie
- Engineering Research Center of Continuous Extrusion, Ministry of Education, Dalian Jiaotong University, Dalian, 116028, China
| | - Norbert Hort
- Magnesium Innovation Center, Helmholtz-Zentrum Geesthacht, D-21502, Geesthacht, Germany
| | - Minfang Chen
- School of Materials Science and Engineering, Tianjin University of Technology, Tianjin, 300384, China
| | - Renguo Guan
- Engineering Research Center of Continuous Extrusion, Ministry of Education, Dalian Jiaotong University, Dalian, 116028, China
| | - Sviatlana Ulasevich
- Infochemistry Scientific Center, ITMO University, St. Petersburg, 192007, Russia
| | - Ekaterina V Skorb
- Infochemistry Scientific Center, ITMO University, St. Petersburg, 192007, Russia
| | - Dapeng Zhao
- College of Biology, Hunan University, 410082, Changsha, China
| | - Yili Liu
- Department of Urology, China Medical University, Shenyang, 110084, China
| | - Patricia Holt-Torres
- Department of Bioengineering, Bourns College of Engineering, University of California at Riverside, CA, 92521, USA
| | - Huinan Liu
- Department of Bioengineering, Bourns College of Engineering, University of California at Riverside, CA, 92521, USA
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Khoddami S, Chew BH, Lange D. Problems and solutions of stent biofilm and encrustations: A review of literature. Turk J Urol 2020; 46:S11-S18. [PMID: 33052843 DOI: 10.5152/tud.2020.20408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
A ureteral stent is a commonly implanted urological device in patients with urinary tract obstruction. The main role of these stents is to allow adequate drainage of urine from the kidney into the bladder. Individuals with strictures, tumors, or obstructions from urinary stones do not have adequate urine flow and require ureteral stents as a part of their treatment to avoid potential hydronephrosis and renal failure. Although ureteral stents are highly effective in treating urinary tract obstructions, they have associated morbidities, such as biofilm formation and encrustation. Researchers have studied about how to diminish these negative outcomes by developing novel stent materials. Different coatings and biomaterials have been developed to reduce bacterial adhesion and crystal deposition onto the stent surfaces. Moreover, new investigation technologies, such as microfluidic platforms and encrustation sensors, have been utilized to better study the stents. Biofilms and encrustations can stem from bacterial origins; therefore, understanding the urinary microbiome will also provide insight into the solutions for treating them. There are still some gaps in our knowledge regarding the exact underlying mechanisms of stent-associated biofilms and encrustation. Future studies should include continuous testing of novel stent biomaterials for safety and efficacy, developing new technologies for identifying and extracting biofilms, enriching the assessment of stent encrustation, and diving deeper into understanding the urinary microbiome.
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Affiliation(s)
- Sara Khoddami
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ben H Chew
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Dirk Lange
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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In vivo assessment of biodegradable magnesium alloy ureteral stents in a pig model. Acta Biomater 2020; 116:415-425. [PMID: 32949824 DOI: 10.1016/j.actbio.2020.09.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
Today, ureteral stent technology is making progress towards the reduction of complications and patient discomfort. Therefore, magnesium alloys have become excellent candidate materials for manufacturing ureteral stents due to their biodegradability and antibacterial activity. Built on our previous work on biodegradable magnesium alloys, this article reports a semisolid rheo-formed magnesium implant that displays degradability and biocompatibility in vivo, and feasibility as ureteral stents in a pig model. Refined non-dendritic microstructure was observed in the rheo-formed alloy, whose grain size and shape factor were ca. 25.2 μm and ca. 1.56 respectively. Neither post-interventional inflammation nor pathological changes were observed in the urinary system during the implantation period of 14 weeks, and the degradation profile (14 weeks) meets the common requirement for the indwelling time of ureteral stents (8 to 16 weeks). Furthermore, histopathological observation and urinalysis results confirmed that the alloy had significantly higher antibacterial activity than the medical-grade stainless steel control. To our knowledge, this is the first in vivo study of biodegradable magnesium alloy as urinary implants in large animal models. Our results demonstrate that magnesium alloys may be a reasonable option for manufacturing biodegradable ureteral stents.
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