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Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens 2024; 13:393. [PMID: 38787246 PMCID: PMC11124157 DOI: 10.3390/pathogens13050393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.
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Affiliation(s)
- Nesrine Bouhrour
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
| | - Peter H. Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Farida Bendali
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
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Singh R, Samaddar A, Duchene D, Waller S, Yang X. Recanalize ureteral stents with focused ultrasound. Med Phys 2023; 50:7349-7358. [PMID: 37153961 DOI: 10.1002/mp.16447] [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: 08/26/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Maintaining ureteral patency is imperative to preventing renal injury and systemic infection. Ureteral stents are small conduits connecting the kidney and the bladder. They have been widely used to treat ureteral obstructions and ureteral leaks. The most problematic and frequent stent-associated complication is stent encrustation. This occurs when mineral crystals (e.g. calcium, oxalate, phosphorus, struvite) are deposited onto the surface and internal lumen of the stent. Encrustation can lead to the obstruction of a stent and increases risk of systemic infection. As a result, ureteral stents need to be replaced typically every 2-3 months. PURPOSE In this study, we present a non-invasive, high-intensity focused ultrasound (HIFU)-based technique to recanalize obstructed stents. By taking advantage of the mechanical force produced by a HIFU beam, including acoustic radiation force, acoustic streaming, and cavitation, HIFU can break up encrustations, clearing the stent of obstruction. METHODS The ureteral stents for this study were obtained from patients undergoing ureteral stent removal. Under the guidance of ultrasound imaging, the encrustation in the stents were located, and then targeted by HIFU at frequencies of 0.25 and 1 MHz. The duty cycle of HIFU was 10%, and the HIFU burst repetition rate was 1 Hz, while the HIFU amplitude was varied to find the threshold pressure that would displace encrustations. The treatment duration was limited at 2 min (or 120 shots from HIFU). The treatments were carried out in two different orientations (parallel and perpendicular) of the ureteral stent with respect to the HIFU beam. For each setting, five treatments were conducted for a maximum duration of 2 min. During the entire treatment, an ultrasound imaging system was used to monitor the movement of encrustations inside the stent. The peak negative HIFU pressures needed to move the encrustations inside the stent was recorded for quantitative analysis. RESULTS Our results demonstrated that at both 0.25 and 1 MHz ultrasound frequencies, obstructed stents could be recanalized. At 0.25 MHz, the needed average peak negative pressure was 0.52 MPa in parallel orientation and 0.42 MPa in perpendicular orientation. At 1 MHz, the needed average peak negative pressure was 1.10 MPa in parallel orientation and 1.15 MPa in perpendicular orientation CONCLUSIONS: This first in-vitro study has demonstrated the feasibility of non-invasive HIFU to recanalize ureteral stents. This technology has a potential to reduce the need for ureteral stent exchange.
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Affiliation(s)
- Rohit Singh
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Abhirup Samaddar
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - David Duchene
- Department of Urology, University of Kansas Medical Center, Kansas, Kansas, USA
| | - Stephen Waller
- Division of Infectious Diseases, University of Kansas Medical Center, Kansas, Kansas, USA
| | - Xinmai Yang
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
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3
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Li Z, Zhang W, Jiao D, Tian C, Xu K, Zhu H, Han X. All-in-one properties of an anticancer-covered airway stent for the prevention of malignant central airway obstruction. APL Bioeng 2023; 7:036116. [PMID: 37719298 PMCID: PMC10503995 DOI: 10.1063/5.0157341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Malignant central airway obstruction (MCAO) resulting from tumor metastasis and compression severely impairs respiration, posing life-threatening risks. To address this, we employed a synergistic modification strategy, combining cisplatin (CIS) and silver nanoparticles (AgNPs). Polycaprolactone (PCL) served as a drug carrier, enabling the preparation of a functional CIS@AgNPs@PCL fiber membrane-covered airway stent via electrospinning. This approach aimed to enhance the patency rate of MCAO. Characterization via ATR-FTIR, scanning electron microscope-energy-dispersive spectroscopy, and transmission electron microscope confirmed successful immobilization of CIS and AgNPs onto the stent surface. CIS@AgNPs@PCL substantially suppressed non-small cell lung cancer cells (A549), causing DNA damage, ultrastructural disruption, and over 50% apoptosis in 48 h. It also displayed potent antibacterial activity against Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans biofilms. A mouse subcutaneous tumor recurrence model assessed anti-cancer efficacy. CIS@AgNPs@PCL fiber-covered stents significantly inhibited lung cancer tissue and enhanced anti-cancer effects by up-regulating caspase-3 and Bax, while down-regulating Bcl-2. This study's functional airway stent provides a proof-of-concept for an integrated anti-cancer and antibacterial strategy. It promptly restores the lumen, inhibits biofilm formation, prevents tumor progression, and improves postoperative MCAO patency.
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Affiliation(s)
| | - Wenguang Zhang
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Dechao Jiao
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Chuan Tian
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Kaihao Xu
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Haidong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210009, China
| | - Xinwei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
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4
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Wang Y, Ren X, Ji C, Zhong D, Wei X, Zhu Z, Zhou X, Zhang X, Wang S, Qin C, Song N. A modified biodegradable mesh ureteral stent for treating ureteral stricture disease. Acta Biomater 2023; 155:347-358. [PMID: 36402295 DOI: 10.1016/j.actbio.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
Ureteral stricture disease (USD) is a common urologic condition. Patients with ureteral stricture disease may suffer from ipsilateral flank pain, nausea, urinary calculi, infection, and impaired renal function. The treatments of USD include surgery, followed by implantation of the ureteral stent to aid the drainage of the urine. The traditional ureteral stent may sometimes cause urological infection, encrustation, and discomfort. To decrease the complication of the ureteral stent, we modified the structure and material based on the traditional ureteral stent. The traditional nondegradable Double-J shape tubular ureteral stent was turned into the biodegradable mesh ureteral stent. The modified mesh ureteral stent and Double-J ureteral stent were inserted into the ureters of the USD animals, respectively. The results of the gross morphology, serology, urinalysis, histology, microstructure, et al. demonstrated that modified mesh ureteral stent has a favorable ability in supporting the ureter and has no effect on cell proliferation, migration, apoptosis, and cell cycle of the human uroepithelial cells. The mesh ureteral stent could relieve ureter obstruction and can be slowly biodegraded after 3-5 months of implantation without the need for a second surgery to remove the stent. Compared to the Double-J ureteral stent, the modified mesh ureteral stent has a lower rate of urinary tract infection and less encrustation. It is expected to be an alternative treatment approach for USD. However, due to the limited number of animals and clinical data, further study focused on the application value in clinical practice are essential. STATEMENT OF SIGNIFICANCE: This study demonstrates: 1. A modified biodegradable mesh ureteral stent; 2. Without the need for a second surgery to remove the stent; 3. A lower rate of urinary tract infection and less encrustation than a double-J ureteral stent; 4. An alternative treatment approach for USD.
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Affiliation(s)
- Yichun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xiaohan Ren
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Chengjian Ji
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Da Zhong
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xiyi Wei
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Zheng Zhu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xuan Zhou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xi Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Shuai Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Chao Qin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China.
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu 210029, China; The Affiliated Kezhou People's Hospital of Nanjing Medical University, China.
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5
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Rodriguez-Alvarez JS, Kratky L, Yates-Alston S, Sarkar S, Vogel K, Gutierrez-Aceves J, Levi N. A PEDOT nano-composite for hyperthermia and elimination of urological bacteria. BIOMATERIALS ADVANCES 2022; 139:212994. [PMID: 35882143 DOI: 10.1016/j.bioadv.2022.212994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/22/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
Novel modalities for overcoming recurrent urinary tract infections associated with indwelling urinary catheters are needed, and rapidly induced hyperthermia is one potential solution. PEDOT nanotubes are a class of photothermal particles that can easily be incorporated into silicone to produce thin, uniform coating on medical grade silicone catheters; subsequent laser stimulation therein imparts temperature elevations that can eliminate bacteria and biofilms. PEDOT silicone coatings are stable following thermal sterilization and repeated heating and cooling cycles. Laser stimulation can induce temperature increases of up to 55 °C in 300 s, but only 45 s was needed for ablation of UTI inducing E. coli biofilms in vitro. This work also demonstrates that mild hyperthermia of 50 °C, applied for only 31 s in the presence of antibiotics could eliminate E. coli biofilm as effectively as high temperatures. This work culminates in the evaluation of the PEDOT NTs for photothermal elimination of E. coli in an in vivo model to demonstrate the safety and effectiveness of a photothermal nanocomposite (16 s treatment time) for rapid clearance of E. coli.
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Affiliation(s)
- Juan Sebastian Rodriguez-Alvarez
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States of America; Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Lauren Kratky
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Shaina Yates-Alston
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Santu Sarkar
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Kenneth Vogel
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Jorge Gutierrez-Aceves
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Nicole Levi
- Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States of America.
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Gorji Daroonkolaee A, Fakhr Yasseri A, Khatami F, Saatchi M, Moradi Tabriz H, Afsari R, Rakebi MM, Tehranipour E, Gholamnejad M, Mashhadi R, Aghamir SMK. Bacterial colonization in three different parts of double J stent. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221081399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Due to the extensive use of indwelling stents and catheters in urology, bacterial colonization on these materials is a significant cause of infections in this group of patients. This study aims to investigate and compare the bacterial colonization in urine and in the three zones of the double J (DJ) stent. Methods: Between August 2019 and May 2020, 67 patients (18–78 years old) who underwent DJ stenting were recruited in the study. Surgeries before stenting included transurethral lithotripsy (TUL), percutaneous nephrolithotomy (PCNL), or diagnostic ureteroscopy. Before stenting, sterile urine samples were collected, and urinary cultures were performed, and the same procedure was done after removal of the DJ stents. DJ stent cultures were also performed. Results: 61 patients were analyzed. The mean age of all patients was 53 ± 16 years. The mean time of DJ installation in all patients was 27.6 ± 6.7 days (14–43 days). In these three parts of the DJ, 70.5%, 67.2%, and 72.1% of patients were without a colony, respectively. The microorganism distribution is approximately the same in the lower and upperparts, and Escherichia coli has the highest frequency (11.5%). The odds ratio (OR) of contamination was significantly lower in men than in women, but overweight and diabetes were not associated. Conclusion: The severity and pattern of bacterial colonization are not significantly different in the proximal, distal, and middle parts of the DJ stent.
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Affiliation(s)
| | | | - Fatemeh Khatami
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
| | - Mohammad Saatchi
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Iran
| | - Hedieh Moradi Tabriz
- Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Iran
| | - Roohollah Afsari
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
| | | | - Elham Tehranipour
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
| | - Maryam Gholamnejad
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
| | - Rahil Mashhadi
- Urology Research Center (URC), Tehran University of Medical Sciences, Iran
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Domingues B, Pacheco M, Cruz JE, Carmagnola I, Teixeira‐Santos R, Laurenti M, Can F, Bohinc K, Moutinho F, Silva JM, Aroso IM, Lima E, Reis RL, Ciardelli G, Cauda V, Mergulhão FJ, Gálvez FS, Barros AA. Future Directions for Ureteral Stent Technology: From Bench to the Market. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202100158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Beatriz Domingues
- 3B's Research Group‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark‐Parque Barco Guimarães 4805‐017 Portugal
- ICVS/3B's‐PT Government Associate Laboratory Braga/Guimarães 4805‐017 Portugal
| | - Margarida Pacheco
- 3B's Research Group‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark‐Parque Barco Guimarães 4805‐017 Portugal
- ICVS/3B's‐PT Government Associate Laboratory Braga/Guimarães 4805‐017 Portugal
| | - Julia E. Cruz
- Endourology‐Endoscopy Department Minimally Invasive Surgery Centre Jesús Usón Cáceres 10071 Spain
| | - Irene Carmagnola
- Department of Mechanical and Aerospace Engineering Politecnico di Torino Turin 10129 Italy
- Polito BIOMedLAB Politecnico di Torino Turin 10129 Italy
| | - Rita Teixeira‐Santos
- LEPABE–Laboratory for Process Engineering Environment Biotechnology and Energy Faculty of Engineering University of Porto Porto 4200‐465 Portugal
| | - Marco Laurenti
- Department of Applied Science and Technology Politecnico di Torino Turin 10129 Italy
| | - Fusun Can
- Department of Medical Microbiology School of Medicine Koc University Istanbul 34450 Turkey
| | - Klemen Bohinc
- Faculty of Health Sciences University of Ljubljana Ljubljana 1000 Slovenia
| | - Fabíola Moutinho
- i3S‐Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto 4200‐135 Portugal
- INEB‐Instituto de Engenharia Biomédica Universidade do Porto Porto 4200‐135 Portugal
| | - Joana M. Silva
- 3B's Research Group‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark‐Parque Barco Guimarães 4805‐017 Portugal
- ICVS/3B's‐PT Government Associate Laboratory Braga/Guimarães 4805‐017 Portugal
| | - Ivo M. Aroso
- 3B's Research Group‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark‐Parque Barco Guimarães 4805‐017 Portugal
- ICVS/3B's‐PT Government Associate Laboratory Braga/Guimarães 4805‐017 Portugal
| | - Estêvão Lima
- School of Health Sciences Life and Health Sciences Research Institute (ICVS) University of Minho Braga 4710‐057 Portugal
| | - Rui L. Reis
- 3B's Research Group‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark‐Parque Barco Guimarães 4805‐017 Portugal
- ICVS/3B's‐PT Government Associate Laboratory Braga/Guimarães 4805‐017 Portugal
| | - Gianluca Ciardelli
- Department of Mechanical and Aerospace Engineering Politecnico di Torino Turin 10129 Italy
- Polito BIOMedLAB Politecnico di Torino Turin 10129 Italy
| | - Valentina Cauda
- Department of Applied Science and Technology Politecnico di Torino Turin 10129 Italy
| | - Filipe J. Mergulhão
- LEPABE–Laboratory for Process Engineering Environment Biotechnology and Energy Faculty of Engineering University of Porto Porto 4200‐465 Portugal
| | - Federico S. Gálvez
- Endourology‐Endoscopy Department Minimally Invasive Surgery Centre Jesús Usón Cáceres 10071 Spain
| | - Alexandre A. Barros
- 3B's Research Group‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark‐Parque Barco Guimarães 4805‐017 Portugal
- ICVS/3B's‐PT Government Associate Laboratory Braga/Guimarães 4805‐017 Portugal
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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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9
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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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10
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Ramachandra M, Mosayyebi A, Carugo D, Somani BK. Strategies to Improve Patient Outcomes and QOL: Current Complications of the Design and Placements of Ureteric Stents. Res Rep Urol 2020; 12:303-314. [PMID: 32802807 PMCID: PMC7403435 DOI: 10.2147/rru.s233981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
Abstract
Ureteric stents have played a vital role in relieving urinary obstruction in many urological conditions. Although they are extremely successful, stents have been associated with complications and reduced patients' health-related quality of life (HRQoL). There are many factors that may affect the quality and longevity of stents. In this review, we have highlighted the journey and innovation of ureteric stents through the modern day. A literature review was conducted to identify relevant articles over the last 20 years. There is a plethora of evidence with various indications for the use of ureteral stents and how they affect QoL. There is still ongoing research to develop the ideal stent with reduced encrustation, one that resists infection and is also comfortable for the patients. Stents made from metal alloys, polymers and biodegradable materials have unique properties in their own right but also have certain deficiencies. These have been discussed along with an overview of newly developed stents. Certain pharmacological adjuncts have also been highlighted that may be useful to improve patient's tolerance to stents. In summary, this paper describes the features of the different types of stents and the problems that are frequently encountered, including effect on patients' HRQoL and financial burden to healthcare providers.
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Affiliation(s)
- Meghana Ramachandra
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Ali Mosayyebi
- Mechanical Engineering Department, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
- Institute for Life Sciences (IfLS), University of Southampton, UK
| | - Dario Carugo
- Mechanical Engineering Department, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
- Institute for Life Sciences (IfLS), University of Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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11
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12
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Tognarelli A, Faggioni L, Manassero F, Gadducci A, Selli C. A case report of endorectal displacement of a right ureteral stent following radiochemotherapy and Bevacizumab. BMC Urol 2019; 19:128. [PMID: 31818277 PMCID: PMC6902463 DOI: 10.1186/s12894-019-0566-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background The angiogenesis inhibitor monoclonal antibody Bevacizumab is presently the standard treatment for numerous neoplasms but particular toxicities are emerging, such as hypertension, haemorrhage, thromboembolism, gastrointestinal perforation, fistulae, and delayed wound healing. The addition of Bevacizumab to radio and chemotherapy has improved the overall survival rate in patients with metastatic, persistent or recurrent cervical carcinoma. However an increased risk of enteric or urinary fistula formation has been documented, related to hypoxia which is induced by the inhibition of angiogenesis. Moreover, previous pelvic surgery, repeated ureteral stenting and radiation are additional risk factors. Case presentation We describe the remarkable case of a right ureteral stent displacement inside the rectum lumen in a patient treated with Bevacizumab for pelvic recurrence of cervical cancer. The patient was referred to our Urology Department with urinary sepsis and bilateral hydronephrosis. Right ureteral stent substitution was planned; at cystoscopy the distal loop of the stent was not visualized inside the bladder. The presence of the distal loop of the right ureteral inside the rectum was clearly demonstrated with a CT scan. Conclusions Since Bevacizumab is increasingly used in the treatment of gynaecological neoplasms and indwelling ureteral stents are often required to treat or prevent ureteral compressions, similar cases are likely to be diagnosed and this complication should be considered in the management of advanced pelvic cancers.
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Affiliation(s)
- Alessio Tognarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Sections of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy.
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Francesca Manassero
- Department of Translational Research and New Technologies in Medicine and Surgery, Sections of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Section of Gynecologic Oncology, University of Pisa, Pisa, Italy
| | - Cesare Selli
- Department of Translational Research and New Technologies in Medicine and Surgery, Sections of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
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13
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De Grazia A, Somani BK, Soria F, Carugo D, Mosayyebi A. Latest advancements in ureteral stent technology. Transl Androl Urol 2019; 8:S436-S441. [PMID: 31656749 DOI: 10.21037/tau.2019.08.16] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Urological diseases such as tumours, kidney stones, or strictures in the ureter can lead to a number of health consequences, including life-threatening complications. Ureteral stents have been widely used as a valid solution to restore compromised urological function. Despite their clinical success, stents are subject to failure due to encrustation and biofilm formation, potentially leading to urinary tract infection. The current review focuses on recent advancements in ureteral stent technology, which have been reported in recent scientific journals or patents. Web of Science and Google Scholar have been used as a search engine to perform this review, using the keywords "Ureteral + Stent + Design", "Ureteral + Stent + Material + Coating", "Ureteric + Stent" and "Ureteral + Stent". A significant proportion of technological developments has focused on innovating the stent design to overcome migration and urinary reflux, as well as investigating novel materials and coatings to prevent biofilm formation, such as poly(N,N-dimethylacrylamide) (PDMMA) and swellable polyethylene glycol diacrylate (PEGDA). Biodegradable ureteral stents (BUS) have also emerged as a new generation of endourological devices, overcoming the "forgotten stent syndrome" and reducing healthcare costs. Moreover, efforts have been made to develop pre-clinical test methods, both experimental and computational, which could be employed as a screening platform to inform the design of novel stent technologies.
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Affiliation(s)
- Antonio De Grazia
- Bioengineering Science Research Group, Faculty of Engineering and the Physical Sciences, University of Southampton, Southampton, UK.,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Federico Soria
- Department of Endoscopy-Endourology, Minimally Invasive Surgery Centre-Jesus Usón, Cáceres, Spain
| | - Dario Carugo
- Bioengineering Science Research Group, Faculty of Engineering and the Physical Sciences, University of Southampton, Southampton, UK.,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK
| | - Ali Mosayyebi
- Bioengineering Science Research Group, Faculty of Engineering and the Physical Sciences, University of Southampton, Southampton, UK.,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK
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14
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Obermeier A, Würstle S, Tübel J, Stolte P, Feihl S, Lipovcic N, Lanzinger S, Mühlhofer H, Weber A, Schmid RM, Burgkart R, Schneider J. Novel antimicrobial coatings based on polylactide for plastic biliary stents to prevent post-endoscopic retrograde cholangiography cholangitis. J Antimicrob Chemother 2019; 74:1911-1920. [DOI: 10.1093/jac/dkz128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/26/2019] [Accepted: 03/06/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Obermeier
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Silvia Würstle
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Jutta Tübel
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Philipp Stolte
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Susanne Feihl
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Nikolina Lipovcic
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Sonja Lanzinger
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Heinrich Mühlhofer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Andreas Weber
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Rainer Burgkart
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Jochen Schneider
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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15
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Tailly T, Van Haute C. Editorial on: In Vitro Effects of a Novel Coating Agent on Bacterial Biofilm Development on Ureteral Stents by Szell et al. (From: Szell T, Dressler FF, Goelz H, et al. J Endourol 2019;33:225–231; DOI: 10.1089/end.2018.0616). J Endourol 2019; 33:232-233. [DOI: 10.1089/end.2018.0907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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