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Wen KC, Li ZA, Liu JH, Zhang C, Zhang F, Li FQ. Recent developments in ureteral stent: Substrate material, coating polymer and technology, therapeutic function. Colloids Surf B Biointerfaces 2024; 238:113916. [PMID: 38636438 DOI: 10.1016/j.colsurfb.2024.113916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
The ureteral stent is an effective treatment for clinical ureteral stricture following urological surgery, and the functional coating of the stent could effectively inhibit bacterial colonization and other complications. The present review provides an analysis and description of the materials used in ureteral stents and their coatings. Emphasis is placed on the technological advancements of functional coatings, taking into consideration the characteristics of these materials and the properties of their active substances. Furthermore, recent advances in enhancing the therapeutic efficacy of functional coatings are also reviewed. It is anticipated that this article will serve as a valuable reference providing insights for future research development on new drug-loaded ureteral stents.
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Affiliation(s)
- Kai-Chao Wen
- School of Medicine, Shanghai University, Shanghai 200444, China; Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China
| | - Zheng-An Li
- School of Medicine, Shanghai University, Shanghai 200444, China; Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China
| | - Ji-Heng Liu
- Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China
| | - Chuan Zhang
- School of Medicine, Shanghai University, Shanghai 200444, China.
| | - Feng Zhang
- Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China.
| | - Feng-Qian Li
- School of Medicine, Shanghai University, Shanghai 200444, China; Department of Urology/Pharmaceutics, Shanghai Eighth People's Hospital, Shanghai 200235, China.
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Liu M, Liu S, Mao Q, Zou Q, Cui Y, Wu J. Comparison of the efficacy and complications of tolterodine and α-adrenergic receptor blockers in improving ureteral stent-related symptoms: A systematic review and meta-analysis. PLoS One 2024; 19:e0302716. [PMID: 38701097 PMCID: PMC11068181 DOI: 10.1371/journal.pone.0302716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE We conducted a systematic evaluation of the therapeutic efficacy and complications of tolterodine and α-adrenergic receptor blockers in alleviating ureteral stent-related symptoms. METHODS Until August 2023, we conducted a comprehensive literature search on PubMed, Embase, Web of Science, and Cochrane Library to identify randomized controlled trials evaluating the efficacy and complications of tolterodine and α-adrenergic receptor blockers in treating ureteral stent-related symptoms. Two reviewers independently screened studies and extracted data. The scores from various domains of the Ureteral Stent Symptom Questionnaire (USSQ) were summarized and compared, and statistical analysis was performed using RevMan 5.4.0 software. RESULTS A total of 8 studies met the inclusion criteria for our analysis. These studies were conducted at different centers. All studies were randomized controlled trials, involving a total of 487 patients, with 244 patients receiving α-adrenergic receptor blockers and 243 patients receiving tolterodine. The results showed that tolterodine demonstrated significantly better improvement in body pain (MD, 1.56; 95% CI [0.46, 2.66]; p = 0.005) (MD, 0.46; 95% CI [0.12, 0.80]; p = 0.008) (MD, 3.21; 95% CI [1.89, 4.52]; p = 0.00001) among patients after ureteral stent placement compared to α-adrenergic receptor blockers at different time points. Additionally, at 4 weeks, tolterodine showed superior improvement in general health (MD, 0.15; 95% CI [0.03, 0.27]; p = 0.01) and urinary symptoms (MD, 1.62; 95% CI [0.59, 2.66]; p = 0.002) compared to α-adrenergic receptor blockers, while at 6 weeks, tolterodine showed better improvement in work performance (MD, -1.60; 95% CI [-2.73, -0.48]; p = 0.005) compared to α-adrenergic receptor blockers. Additionally, the incidence of dry mouth (RR, 4.21; 95% CI [1.38, 12.87]; p = 0.01) is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, there were no significant statistical differences between the two drugs in other outcomes. CONCLUSION This meta-analysis suggests that tolterodine is superior to α-adrenergic receptor blockers in improving physical pain symptoms after ureteral stent placement, while α-adrenergic receptor blockers are more effective than tolterodine in enhancing work performance. Additionally, the incidence of dry mouth is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, higher-quality randomized controlled trials are needed to further investigate this issue.
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Affiliation(s)
- Ming Liu
- Second Clinical Medical College, Binzhou Medical University, Yantai, Shandong, China
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Shangjing Liu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Qiancheng Mao
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Qingsong Zou
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Yuanshan Cui
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
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Kallidonis P, Adamou C, Castillo SV, Liourdi D, Liatsikos E, Lange D. Drug-delivering devices in the urinary tract: A systematic review. Arab J Urol 2021; 19:191-204. [PMID: 34104496 PMCID: PMC8158184 DOI: 10.1080/2090598x.2021.1885948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective : To systematically review the use of drug-eluting stents (DES) and drug-coated balloons (DCB) in urology. Materials and Methods The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Scopus, Web of science and Cochrane Library online databases were searched in February 2019. Experimental and clinical studies, which included the placement of a DES or dilatation with DCB for investigating their potential use in the urinary tract for the management of ureteric or urethral pathologies, were included. The primary endpoint was to evaluate the current use of DES and DCB in urology. Results A total of 29 articles were included in the systematic review. A total of 10 studies tested DES or DCB containing anti-proliferative agents (paclitaxel, zotarolimus, sirolimus, halofugione). Antibiotic agent-containing DES were tested in nine studies (triclosan, quinolones, teicoplanin, nitrofurantoin, silver sulfadiazine). A total of eight studies investigated the release of anti-inflammatory agents by DES (ketorolac, indomethacin, EW-7197). Another group studied heparin-eluting stents. Conclusion Despite the inconclusive outcomes of the three randomised controlled trials, drug-coated/eluting devices constitute a promising field in urology for the prevention of complications associated with conventional stents including pain and encrustation. Pre-clinical in vitro and in vivo studies have shown their ability to mitigate inflammation, inhibit re-stenosis and improve pain as indicated by declined use of anti-inflammatory drugs. Abbreviations: DES: drug-eluting stents; DCB: drug-coated balloons; DCS: drug-coated stents; HF: halofungione; MCP-1: monocyte chemoattractant protein 1; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PTCA: percutaneous transluminal coronary angioplasty; RANTES: regulated on activation, normal T-cell expressed and secreted; RCT: randomised controlled trial; USSQ, Ureteric Stent Symptoms Questionaire.
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Affiliation(s)
- Panagiotis Kallidonis
- Department of Urology, University Hospital of Patras, Patras, Greece.,Endourological Society, Ureteral Stent Research Group
| | | | | | | | | | - Dirk Lange
- Endourological Society, Ureteral Stent Research Group.,Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Huang ZA, Scotland KB, Li Y, Tan J, Kung SHY, Chew BH, Chen DDY, Lange D. Determination of urinary prostaglandin E 2 as a potential biomarker of ureteral stent associated inflammation. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1145:122107. [PMID: 32315976 DOI: 10.1016/j.jchromb.2020.122107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/04/2020] [Accepted: 04/04/2020] [Indexed: 12/21/2022]
Abstract
Ureteral stents are the most widely used surgical implant in urology. However, they may cause adverse effects to patients, including pain, discomfort, and inflammation. In this work, the inflammatory effect of stent placement and the associated elevation of cyclooxygenase-2 (COX-2) expression were observed. Furthermore, a capillary electrophoresis mass spectrometry (CE-MS) based approach was subsequently developed to quantify urinary prostaglandin E2 (PGE2), a COX-2 metabolite known to contribute to inflammatory renal diseases, to further interrogate the role of this pathway. Urine samples were cleaned and preconcentrated by solid-phase extraction (SPE), and an on-line sample stacking method was used for the enrichment of analytes. The accuracy, precision, and specificity of this method were validated. Standard addition methods were performed to assess the reliability of using deuterated internal standards (IS) in compensating the remaining matrix effect after SPE as well as the detector fluctuation. Through the analysis of 32 pig urine samples, a statistically significant increase of PGE2 was observed in the stented group compared to the unstented (P = 0.01) and the recovered (P = 0.004) groups. This work determined that stent placement may contribute to COX-2-dependent inflammation and developed a reliable CE-MS based methodology to quantify PGE2 in stented individuals that may further understand the biology of stent-associated inflammation and inform urologic patient management.
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Affiliation(s)
- Zi-Ao Huang
- Department of Chemistry, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Kymora B Scotland
- Department of Urology, University of California Los Angeles, Los Angeles, CA 90024, USA.
| | - Yueyang Li
- Department of Chemistry, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Jiahua Tan
- Department of Chemistry, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Sonia H Y Kung
- Vancouver Prostate Center, Vancouver, BC V5Z 1M9, Canada
| | - Ben H Chew
- Department of Urologic Sciences, The Stone Centre at Vancouver General Hospital, University of British Columbia, Vancouver, BC V6H 3Z6, Canada
| | - David D Y Chen
- Department of Chemistry, University of British Columbia, Vancouver, BC V6T 1Z1, Canada.
| | - Dirk Lange
- Department of Urologic Sciences, The Stone Centre at Vancouver General Hospital, University of British Columbia, Vancouver, BC V6H 3Z6, Canada.
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Sali GM, Joshi HB. Ureteric stents: Overview of current clinical applications and economic implications. Int J Urol 2019; 27:7-15. [PMID: 31549458 DOI: 10.1111/iju.14119] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/01/2019] [Indexed: 12/16/2022]
Abstract
Ureteric stents are one of the most crucial tools used for various clinical conditions in the urological field. Placement of a ureteric stent, for short- or long-term use, remains one of the commonest urological interventional procedures. In the past few decades, ureteral stents have undergone notable technological advancements. However, an ideal stent without significant side-effects is yet to be engineered. Indwelling ureteric stents are often accompanied by physical distress to the patient and clinical complications, such as bacterial adhesion, encrustation, malpositioning, stent fracture and forgotten stent syndrome, that influence patients' health-related quality of life. In the market, different stent types are available, designed to reduce infections, and improve patient symptoms and tolerance. In this review, we have emphasized the recent developments that have taken place in stent design, size, materials and coating. This overview looks at current practices and problems related to stents, along with clinical and economic considerations. Few trial studies have been enumerated in the context of utilization of a ureteral stent symptom questionnaire and various stent models to compare their effects in patients.
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Chew BH, Rebullar KA, Harriman D, McDougall E, Paterson RF, Lange D. Percuflex Helical Ureteral Stents Significantly Reduce Patient Analgesic Requirements Compared to Control Stents. J Endourol 2017; 31:1321-1325. [DOI: 10.1089/end.2017.0349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia
| | - Karla A. Rebullar
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia
| | - David Harriman
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia
| | - Elspeth McDougall
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia
| | - Ryan F. Paterson
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia
| | - Dirk Lange
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia
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Koprowski C, Kim C, Modi PK, Elsamra SE. Ureteral Stent-Associated Pain: A Review. J Endourol 2016; 30:744-53. [DOI: 10.1089/end.2016.0129] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christopher Koprowski
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Christopher Kim
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Parth K. Modi
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sammy E. Elsamra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Ketoprofen-eluting biodegradable ureteral stents by CO2 impregnation: In vitro study. Int J Pharm 2015; 495:651-9. [DOI: 10.1016/j.ijpharm.2015.08.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 11/18/2022]
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10
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Yang L, Whiteside S, Cadieux PA, Denstedt JD. Ureteral stent technology: Drug-eluting stents and stent coatings. Asian J Urol 2015; 2:194-201. [PMID: 29264145 PMCID: PMC5730737 DOI: 10.1016/j.ajur.2015.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 08/24/2015] [Indexed: 02/05/2023] Open
Abstract
Ureteral stents are commonly used following urological procedures to maintain ureteral patency. However, alongside the benefits of the device, indwelling stents frequently cause significant patient discomfort (pain, urgency, frequency) and can become encrusted and infected. The importance of these sequelae is that they are not only bothersome to the patient but can lead to significant morbidity, urinary retention, ureteral damage, recurrent infections, pyelonephritis and sepsis. When these problems occur, stent removal or replacement alongside antibiotic, analgesic and/or other symptom-modifying therapies are essential to successfully treat the patient. In an attempt to prevent such morbidity, numerous approaches have been investigated over the past several decades to modify the stent itself, thereby affecting changes locally within the urinary tract without significant systemic therapy. These strategies include changes to device design, polymeric composition, drug-elution and surface coatings. Of these, drug-elution and surface coatings are the most studied and display the most promise for advancing ureteral stent use and efficacy. This article reviews these two strategies in detail to determine their clinical potential and guide future research in the area.
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Affiliation(s)
- Luo Yang
- Department of Surgery, Division of Urology, No.4 West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Urology of West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Samantha Whiteside
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Peter A Cadieux
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada.,School of Health Sciences, Fanshawe College, London, Ontario, Canada
| | - John D Denstedt
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
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Fiuk J, Bao Y, Calleary JG, Schwartz BF, Denstedt JD. The use of internal stents in chronic ureteral obstruction. J Urol 2014; 193:1092-100. [PMID: 25463984 DOI: 10.1016/j.juro.2014.10.123] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE Despite the lack of a well delineated definition, chronic ureteral obstruction imposes significant quality of life loss, increased pathological morbidity and risk of mortality as well as substantial economic burden. Ureteral stenting serves as an important therapeutic option to alleviate obstruction. Thus, we assessed the recently published literature on chronic ureteral obstruction; treatment options; types, benefits and shortcomings of current ureteral stents; as well as outcomes and complications of chronic ureteral stenting, with the goal of providing concise management guidelines. MATERIALS AND METHODS A systemic literature review was performed on Embase™, PubMed®, Cochrane Controlled Trials Register and Google Scholar™ on ureteral obstruction and internal ureteral stents. Relevant reviews, original research articles and their cited references were examined, and a synopsis of original data was generated on a clinically oriented basis. RESULTS Chronic ureteral obstruction can be classified into compression that is either intrinsic or extrinsic to the ureteral wall, or obstruction that is of a benign or malignant origin. Patients with malignant ureteral obstruction generally have a poor prognosis and are often difficult to treat. The aim of stenting is to adequately drain the upper urinary tracts while minimizing hospitalization and the negative impact on quality of life. Facing the challenge of chronic ureteral obstruction, novel stents with new compositions, materials, coatings and designs have been developed. Metallic stents are emerging as efficacious and financially viable alternatives. Early stent related complications include iatrogenic injury, stent migration or patient discomfort, while late complications include infection, difficulties with stent exchange, hardware malfunction, infection and stent encrustation. CONCLUSIONS Stenting in chronic ureteral obstruction is a complex and challenging problem. Much work is being done in this area and many options are being explored.
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Affiliation(s)
- Julia Fiuk
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Yige Bao
- Division of Urology, Department of Surgery and Department of Microbiology and Immunology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Urology, West China Hospital, Sichuan University, West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - John G Calleary
- Department of Urology, North Manchester General Hospital, Manchester, United Kingdom
| | - Bradley F Schwartz
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois
| | - John D Denstedt
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois.
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Non-vascular drug eluting stents as localized controlled drug delivery platform: Preclinical and clinical experience. J Control Release 2013; 172:105-117. [DOI: 10.1016/j.jconrel.2013.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/03/2013] [Accepted: 08/05/2013] [Indexed: 01/10/2023]
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Mendez-Probst CE, Fernandez A, Denstedt JD. Current Status of Ureteral Stent Technologies: Comfort and Antimicrobial Resistance. Curr Urol Rep 2010; 11:67-73. [DOI: 10.1007/s11934-010-0091-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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