Biodegradable urethral stents

Advancing Toward 3D Printing of Bioresorbable Shape Memory Polymer Stents

Stents have evolved significantly since their introduction to the medical field in the early 1980s, becoming widely used in percutaneous coronary interventions and following nephrological procedures. However, the current commercially available stents do not degrade and remain in the body forever, leading to problems like restenosis in cardiovascular applications or requiring removal procedures in ureteral applications. Efforts to replace metal with resorbable materials have largely been halted after the commercial failure of and safety concerns elicited by Abbott's Absorb stent in 2017. Industry continues to use common polymers such as poly(l-lactide) (PLLA) and polycaprolactone (PCL) for biomedical products, but due to the weak mechanical properties of these bioresorbable materials in comparison to metals, these devices have struggled to accomplish the goals set, increasing risk of thrombosis. 3D printing stents using bioresorbable and shape memory materials could provide a method of patient-personalized production, remove the need for balloon expansion, and limit stent migration, thus bringing a new age of stent technology. The investigation of a range of 3D-printable and bioresorbable shape-memory polymers can provide solutions to the shortcomings of previously explored bioresorbable stents and revitalize the medical device industry efforts into advancing stent technology.

Considerations for the design of polymeric biodegradable products

Several biodegradable polymers are used in many products with short life cycles. The performance of a product is mostly conditioned by the materials selection and dimensioning. Strength, maximum strain and toughness will decrease along its degradation, and it should be enough for the predicted use. Biodegradable plastics can present short-term performances similar to conventional plastics. However, the mechanical behavior of biodegradable materials, along the degradation time, is still an unexplored subject. The maximum strength failure criteria, as a function of degradation time, have traditionally been modeled according to first order kinetics. In this work, hyperelastic constitutive models are discussed. An example of these is shown for a blend composed of poly(L-lactide) acid (PLLA) and polycaprolactone (PCL). A numerical approach using ABAQUS is presented, which can be extended to other 3D geometries. Thus, the material properties of the model proposed are automatically updated in correspondence to the degradation time, by means of a user material subroutine. The parameterization was achieved by fitting the theoretical curves with the experimental data of tensile tests made on a PLLA-PCL blend (90:10) for different degradation times. The results obtained by numerical simulations are compared to experimental data, showing a good correlation between both results.

Visco-Elastic-Plastic Properties of Suture Fibers Made of PLA-PCL

Aliphatic polyesters, like PGA, PLA, PCL and PDO, among others, are biodegradable materials that find applications in many biomedical devices, from fibers for subcutaneous sutures to other regenerative surgery implants. The main concept among these applications is to use a biodegradable device that temporarily replace the biomechanical functions, avoiding this way the chirurgical procedures to remove the device. However, the dimensioning of these devices is complex, not only because the mechanical properties evolve during degradation, but also because these biodegradable materials cannot be assumed as elastic materials. In more precise terms, the response of an elastic material implies that the loading and unloading paths coincide, the material responds instantaneously to an applied load, its behavior is time-independent and the material returns to its former unloaded configuration upon the removal of external loads. In this work, fibers of non-degraded PLA-PCL were submitted to tensile testing at different rates, to load-unloading cycles at different load levels and with or without delay before reloading, creep and fatigue tests at different levels of load. These results elucidate the viscoelastic/viscoplastic nature of this class of materials. The load-unloading cyclic test results allow determining the different components of the strain: elastic, plastic and viscous. The visco-plastic nature was also reflected on the creep and fatigue results. The findings discussed in this work must be taken into account when designing biomedical devices, to avoid common causes of failure such as laxity or premature rupture.

Urethral strictures

What's known on the subject? and What does the study add? Urethral strictures are common and increasingly common in an ageing population. The treatment is controversial and particularly the relative roles of urethrotomy or urethral dilatation on the one hand and urethroplasty on the other. This review aims to provide a comprehensive overview of the subject including less commonly discussed issues such as the history and pathology of stricture disease. We would hope that a comprehensive overview of the subject will give a sharper perspective to aid the investigation and management of patients with urethral strictures.

Introduction to biodegradable polylactic acid ureteral stent application for treatment of ureteral war injury

OBJECTIVE

• To study the operability and effectiveness of a biodegradable ureteral stent for clinical treatment of ureteral war injury using a canine model.

MATERIALS AND METHODS

• A device was designed and employed to generate firearm fragment wounds in unilateral ureters (on randomly chosen sides) of nine beagles (Group A). The wounded ureters were then debrided and sutured. • Intravenous pyelography (IVP) and radioactive renography were performed 40, 80 and 120 days postoperatively. In Group B, firearm fragment wounds were made to the bilateral ureters in nine beagles. A polylactic acid stent was placed unilaterally (on a randomly chosen side) whereas the ureter on the other side was debrided and sutured without stenting. • Both IVP and radioactive renography were performed 40, 80 and 120 days postoperatively. The operability and effectiveness of the biodegradable ureteral stent were studied thereafter.

RESULTS

• In Group A, hydronephrosis and hydroureter occurred and worsened postoperatively on the wounded sides in all nine beagles. The ratio of the renal partial concentration indices (RPCI) between the kidneys (unwounded side : wounded side) increased. • The ratio of the kidney washout half-time between the kidneys (unwounded side : wounded side) decreased. In Group B, neither hydronephrosis nor hydroureter was found postoperatively in the stented ureters but both occurred in the unstented ureters in all nine beagles. • The ratio of RPCI between kidneys (stented side : unstented side) increased whereas the kidney washout half-time ratio between the stented and unstented sides decreased. Differences were significant.

CONCLUSION

• In Group A, the new canine model for firearm fragment wounds was tested and proved to be operable and effective. In Group B, hydronephrosis and hydroureter were effectively prevented in ureters by biodegradable stent placement compared with the non-stented ureters where hydronephrosis and hydroureter occurred. The renal concentration capacity was effectively protected and the half-time of kidney washout was shortened.

Deformation-induced hydrolysis of a degradable polymeric cylindrical annulus

A thermodynamically consistent framework for describing the response of materials undergoing deformation-induced degradation is developed and applied to a particular biodegradable polymer system. In the current case, energy is dissipated through the mechanism of hydrolytic degradation and its effects are incorporated in the constitutive model by appropriately stipulating the forms for the rate of dissipation and for the degradation-dependent Helmholtz potential which changes with the extent of the degradation of the material. When degradation does not occur, the response of the material follows the response of a power-law generalized neo-Hookean material that fits the response of the non-degraded poly(L: -lactic acid) under uniaxial extension. We study the inflation and extension of a degrading cylindrical annulus and the influence of the deformation on the mechanism of degradation and its consequent mechanical response. Depreciation of mechanical properties due to degradation confers time-dependent characteristics to the response of the biodegradable material: the material creeps when subjected to constant loads and stresses necessary to keep a fixed deformation relax.

Removal of retrievable self-expandable urethral stents: experience in 58 stents

The purpose of this study was to retrospectively evaluate the safety and efficacy of removing retrievable self-expandable urethral stents using a retrieval hook wire. Under fluoroscopic guidance, the removal of 58 polyurethane or PTFE (polytetrafluoroethylene)-covered stents was attempted in 33 patients using a retrieval hook wire. Indications for removal were elective removal (n = 21), stent migration (n = 19), formation of tissue hyperplasia around or inside of the stent (n = 14), stent deformity (n = 3), and severe pain (n = 1). The mean time the stents remained in place was 64.8 +/- 42.9 days (range, 1-177 days). Fifty-six (97%) of the 58 stents were successfully removed using the retrieval hook wire despite the following difficulties; hook wire disconnection (n = 2), untied drawstrings (n = 3), and polyurethane membrane disruption/separation (n = 4). The removal procedure using a retrieval hook wire failed in two stents (3%) which had migrated into the urinary bladder. One of the two stents with migration into the urinary bladder was removed using a snare through the cystostomy route. The overall complication rate was 14% (seven hematuria cases and one urethral tear case), and all were minor and spontaneously resolved without further treatment. In conclusion, removal of retrievable urethral stents using a retrieval hook wire was safe and effective despite some technical difficulties. It is a useful method for allowing temporary stent placement and solving various complications of stent use.

The role of branched polyesters and their modifications in the development of modern drug delivery vehicles

Branched polyesters consisting of poly (vinyl alcohol) (PVA) grafted with chains of poly (lactic-co-glycolic acid) (PLGA) represent a new class of biodegradable polymers showing significant potential for the development of a variety of drug delivery vehicles. The amphiphilic character and the resulting increase in hydrophilicity of this class of polymers provide advantages when packaging sensitive drug molecules, such as proteins, peptides or DNA. Furthermore, the PVA backbone can be modified, for example, with sulfobutyl moieties or amine structures, to create polymers with negative or positive charges. The ability to modify not only the backbone but also the length of the PLGA side chains results in an extremely flexible polymer system, which can be adapted to meet the needs of almost any drug substance. Further, the rate of biodegradation may also be manipulated through polymer modification to achieve half-lives ranging from several hours to several weeks. This review provides an overview of the three major groups of branched polyesters based upon poly (vinyl alcohol)-grafted poly (lactic-co-glycolic acid) (PVA-g-PLGA), namely, the neutrally charged PVA-g-PLGA, the negatively charged sulfobutyl-modified PVA-g-PLGA and the positively charged amine-modified PVA-g-PLGA, as well as their use in various drug delivery systems.