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  • Review Article
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Technology Insight: novel ureteral stent materials and designs

Abstract

Ureteral stents are an important tool for aiding upper urinary tract drainage, but can cause significant patient morbidity. Common problems include stent-induced pain, hematuria, dysuria, infection, and encrustation. From a urologist's perspective, stents must be easy to maneuver in the urinary tract, radiopaque, and affordable. Since the development of the modern day stent in 1978, stents have evolved to include softer biomaterials that are more resistant to encrustation and infection. An ideal biomaterial is one that is not affected by its environment and does not elicit reactive changes in surrounding tissues. To date, the ideal biomaterial or stent does not exist. This review discusses developments that address the issues of infection, biofilm formation, encrustation, and patient comfort. Stent materials including polyurethane, silicone, biodegradable substances and new combination polymers are reviewed, in addition to novel stent coatings such as heparin, hydrogel, and silver nitrate. Ureteral stent technologies currently lag behind vascular stents, particularly drug-eluting stents, but new developments will continue to improve these essential urological tools.

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References

  1. Houghton Mifflin Company (2000) The American Heritage® Dictionary of the English Language, edn 4. Boston: Houghton Mifflin Company

  2. Bloom DA et al. (1999) Stents and related terms: a brief history. Urology 54: 767–771

    Article  CAS  Google Scholar 

  3. Finney RP (1978) Experience with new double J ureteral catheter stent. J Urol 120: 678–681

    Article  CAS  Google Scholar 

  4. Paick SH et al. (2003) Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent. Urology 62: 214–217

    Article  Google Scholar 

  5. Damiano R et al. (2002) Early and late complications of double pigtail ureteral stent. Urol Int 69: 136–140

    Article  Google Scholar 

  6. Singh I et al. (2001) Severely encrusted polyurethane ureteral stents: management and analysis of potential risk factors. Urology 58: 526–531

    Article  CAS  Google Scholar 

  7. Riedl CR et al. (1999) Bacterial colonization of ureteral stents. Eur Urol 36: 53–59

    Article  CAS  Google Scholar 

  8. Joshi HB et al. (2003) Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 169: 1065–1069

    Article  CAS  Google Scholar 

  9. Hosking DH et al. (1999) Is stenting following ureteroscopy for removal of distal ureteral calculi necessary? J Urol 161: 48–50

    Article  CAS  Google Scholar 

  10. Denstedt JD et al. (2001) A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol 165: 1419–1422

    Article  CAS  Google Scholar 

  11. Damiano R et al. (2004) Stent positioning after ureteroscopy for urinary calculi: the question is still open. Eur Urol 46: 381–387

    Article  Google Scholar 

  12. Gorman SP et al. (1998) Characterization and assessment of a novel poly(ethylene oxide)/polyurethane composite hydrogel (Aquavene) as a ureteral stent biomaterial. J Biomed Mater Res 39: 642–649

    Article  CAS  Google Scholar 

  13. Watterson JD et al. (2003) Swarming of Proteus mirabilis over ureteral stents: a comparative assessment. J Endourol 17: 523–527

    Article  Google Scholar 

  14. Tunney MM et al. (1997) Assessment of urinary tract biomaterial encrustation using a modified Robbins device continuous flow model. J Biomed Mater Res 38: 87–93

    Article  CAS  Google Scholar 

  15. Jones DS et al. (2004) Relationship between biomedical catheter surface properties and lubricity as determined using textural analysis and multiple regression analysis. Biomaterials 25: 1421–1428

    Article  CAS  Google Scholar 

  16. Marx M et al. (1988) The effects of various indwelling ureteral catheter materials on the normal canine ureter. J Urol 139: 180–185

    Article  CAS  Google Scholar 

  17. Mardis HK and Kroeger RM (1988) Ureteral stents. Materials. Urol Clin North Am 15: 471–479

    CAS  PubMed  Google Scholar 

  18. Choong S and Whitfield H (2000) Biofilms and their role in infections in urology. BJU Int 86: 935–941

    Article  CAS  Google Scholar 

  19. Tieszer C et al. (1998) Conditioning film deposition on ureteral stents after implantation. J Urol 160: 876–881

    Article  CAS  Google Scholar 

  20. Reid G et al. (2001) Oral fluoroquinolone therapy results in drug adsorption on ureteral stents and prevention of biofilm formation. Int J Antimicrob Agents 17: 317–319

    Article  CAS  Google Scholar 

  21. Multanen M et al. (2000) Bacterial adherence to silver nitrate coated poly-L-lactic acid urological stents in vitro. Urol Res 28: 327–331

    Article  CAS  Google Scholar 

  22. Multanen M et al. (2002) Biocompatibility, encrustation and biodegradation of ofloxacine and silver nitrate coated poly-L-lactic acid stents in rabbit urethra. Urol Res 30: 227–232

    Article  CAS  Google Scholar 

  23. Riedl CR et al. (2002) Heparin coating reduces encrustation of ureteral stents: a preliminary report. Int J Antimicrob Agents 19: 507–510

    Article  CAS  Google Scholar 

  24. Marmieri G et al. (1996) Evaluation of slipperiness of catheter surfaces. J Biomed Mater Res 33: 29–33

    Article  CAS  Google Scholar 

  25. Desgrandchamps F et al. (1997) An in vitro comparison of urease-induced encrustation of JJ stents in human urine. Br J Urol 79: 24–27

    Article  CAS  Google Scholar 

  26. Zupkas P et al. (2000) Pentosanpolysulfate coating of silicone reduces encrustation. J Endourol 14: 483–488

    Article  CAS  Google Scholar 

  27. Stickler DJ et al. (2002) Strategies for the control of catheter encrustation. Int J Antimicrob Agents 19: 499–506

    Article  CAS  Google Scholar 

  28. Tunney MM and Gorman SP (2002) Evaluation of a poly(vinyl pyrollidone)-coated biomaterial for urological use. Biomaterials 23: 4601–4608

    Article  CAS  Google Scholar 

  29. Chitale SV et al. (2002) The management of ureteric obstruction secondary to malignant pelvic disease. Clin Radiol 57: 1118–1121

    Article  CAS  Google Scholar 

  30. Pauer W and Lugmayr H (1992) Metallic Wallstents: a new therapy for extrinsic ureteral obstruction. J Urol 148: 281–284

    Article  CAS  Google Scholar 

  31. Kulkarni R and Bellamy E (2001) Nickel-titanium shape memory alloy Memokath 051 ureteral stent for managing long-term ureteral obstruction: 4-year experience. J Urol 166: 1750–1754

    Article  CAS  Google Scholar 

  32. Daskalopoulos G et al. (2001) Intraureteral metallic endoprosthesis in the treatment of ureteral strictures. Eur J Radiol 39: 194–200

    Article  CAS  Google Scholar 

  33. Barbalias GA et al. (2002) Ureteropelvic junction obstruction: an innovative approach combining metallic stenting and virtual endoscopy. J Urol 168: 2383–2386

    Article  Google Scholar 

  34. Barbalias GA et al. (2002) Externally coated ureteral metallic stents: an unfavorable clinical experience. Eur Urol 42: 276–280

    Article  Google Scholar 

  35. Amiel GE et al. (2001) Tissue engineered stents created from chondrocytes. J Urol 165: 2091–2095

    Article  CAS  Google Scholar 

  36. Smith TG III et al. (2002) Ureteral replacement using porcine small intestine submucosa in a porcine model. Urology 60: 931–934

    Article  Google Scholar 

  37. Landman J et al. (2004) Laparoscopic mid sagittal hemicystectomy and bladder reconstruction with small intestinal submucosa and reimplantation of ureter into small intestinal submucosa: 1-year followup. J Urol 171: 2450–2455

    Article  Google Scholar 

  38. O'Connor RC et al. (2002) Distal ureteral replacement with tubularized porcine small intestine submucosa. Urology 60: 697

    Article  Google Scholar 

  39. Dunn MD et al. (2000) Clinical effectiveness of new stent design: randomized single-blind comparison of tail and double-pigtail stents. J Endourol 14: 195–202

    Article  CAS  Google Scholar 

  40. Liatsikos EN et al. (2002) Tail stent versus re-entry tube: a randomized comparison after percutaneous stone extraction. Urology 59: 15–19

    Article  Google Scholar 

  41. Stoller ML et al. (2000) An in vitro assessment of the flow characteristics of spiral-ridged and smooth-walled JJ ureteric stents. BJU Int 85: 628–631

    Article  CAS  Google Scholar 

  42. Isotalo T et al. (2002) A bioabsorbable self-expandable, self-reinforced poly-L-lactic acid urethral stent for recurrent urethral strictures: long-term results. J Endourol 16: 759–762

    Article  CAS  Google Scholar 

  43. Laaksovirta S et al. (2002) Interstitial laser coagulation and biodegradable self-expandable, self-reinforced poly-L-lactic and poly-L-glycolic copolymer spiral stent in the treatment of benign prostatic enlargement. J Endourol 16: 311–315

    Article  Google Scholar 

  44. Olweny EO et al. (2002) Evaluation of the use of a biodegradable ureteral stent after retrograde endopyelotomy in a porcine model. J Urol 167: 2198–2202

    Article  Google Scholar 

  45. Taylor WN and McDougall IT (2002) Minimally invasive ureteral stent retrieval. J Urol 168: 2020–2023

    Article  CAS  Google Scholar 

  46. Lingeman JE et al. (2003) Phase I trial of a temporary ureteral drainage stent. J Endourol 17: 169–171

    Article  Google Scholar 

  47. Granada JF et al. (2003) Drug-eluting stents for cardiovascular disorders. Curr Atheroscler Rep 5: 308–316

    Article  Google Scholar 

  48. Beiko DT et al. A double-blinded prospective randomized controlled trial assessing the safety and efficacy of intravesical agents for ureteral stent symptoms following extracorporeal shockwave lithotripsy. J Endourol, in press

  49. Watterson JD et al. (2003) Oxalate-degrading enzymes from Oxalobacter formigenes: a novel device coating to reduce urinary tract biomaterial-related encrustation. J Endourol 17: 269–274

    Article  Google Scholar 

  50. Mittelman M et al. (2004) In vitro antimicrobial release profile of a new triclosan-eluting ureteral stent. J Urol 171: 443

    Article  Google Scholar 

  51. Chew BH et al. (2004) Triclosan loaded ureteral stents reduce Proteus mirabilis 296 infection in a rabbit UTI model. In Proceedings of the 56th Annual Meeting of the Northeastern Section of the American Urological Association: October 28–30, 2004; Savannah, Georgia, in press

    Google Scholar 

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Correspondence to John D Denstedt.

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The authors receive funding and research support from Cook Urological, ACMI Corporation and Boston Scientific Corporation.

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Chew, B., Denstedt, J. Technology Insight: novel ureteral stent materials and designs. Nat Rev Urol 1, 44–48 (2004). https://doi.org/10.1038/ncpuro0014

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