Trans-urethral snare stent removal: a novel, self-constructed innovation for simultaneous ureteral stent removal and safety guidewire insertion

Inner surface modification of polyurethane ureteral stents using plasma-enhanced chemical vapor deposition to improve the resistance to encrustation in a pig model

PURPOSE

We developed a ureteral stent with a non-fouling inner surface using plasma micro-surface modification technology. This study aimed to evaluate the safety and efficacy of this stent in animal model.

MATERIALS AND METHODS

Ureteral stents were placed in five Yorkshire pigs. A bare stent was inserted on one side and an inner surface-modified stent was inserted on the other side. Two weeks after stenting, laparotomy was performed to harvest the ureteral stents. The changes in the inner surface were grossly evaluated using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). In addition, if encrustation was observed, the components were analyzed using Fourier transform infrared spectroscopy. Urine cultures were used for safety assessment.

RESULTS

In all models, urine cultures did not show any bacterial growth before and after stenting, and stent-related complications were not identified. Hard materials were palpable in four bare models. Palpable material was not identified in the modified stent. Calcium oxalate dihydrate/uric acid stones were identified in two bare stents. In the SEM images with EDS, biofilm formation was confirmed in the bare stents. Biofilm formation was significantly less on the inner surface of the modified stent, and the intact surface of the modified stent was larger than that of the bare stent.

CONCLUSIONS

The application of a specialized, plasma-enhanced, chemical vapor deposition technology to the inner surface of ureteral stents was safe and showed resistance to biofilm formation and encrustation.

Efficacy of the novel, innovative, single-use grasper integrated flexible cystoscope for ureteral stent removal: A systematic review

BACKGROUND

We aimed to define the published impact, efficacy, cost-effectiveness and precise role of the Isiris-α device: the world's first sterile, single-use grasper integrated flexible cystoscope (SUGIFC) for ureteral stent removal.

METHODS

After PROSPERO registration (CRD42021228755), the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were utilized. The search terms "Grasper Integrated Flexible Cystoscope," and "Isiris," within the following databases: PubMed, Scopus, Cochrane Library, Web of Science and EMBASE were searched.

RESULTS

In this review, a cumulative total experience (10 publications) included 970 "SUGIFC" procedures (755 patients). However, only 366/970 procedures were actually used for "ureteral stent removal," with the remainder being surveillance cystoscopy only (603/970) or foreign body retrieval (1/970). Procedure-related and device failures in planned "removal of ureteral stents," was reported in 8/366 (346 patients) and 1/366 (346 patients), respectively. The cost-benefit utilizing the SUGIFC device is advantageous compared to "in-theatre" stent removals and favours less busy centres where maintenance, repair and replacement costs are more relevant. Other listed benefits include shorter stent indwelling times, shorter procedure duration, lower rates of bacteriuria and urinary tract infections, fewer emergency department visits and lower readmission rates. Technical limitations include the absence of an independent working channel, a narrower visual field and the lack of image universality since the monitor is device-specific.

CONCLUSION

The SUGIFC device needs to be outweighed against local costs and individual health systems. Its application in ambulatory ureteral stent removal may become significant due to the accessibility and convenience that it offers the attending urologist.