Bacterial Colonization of Ureteral Stents

Riedl, Claus R.; Plas, Eugen; Hübner, W.; Zimmerl, Helga; Ulrich, Walter; Pflüger, Heinz

doi:10.1159/000019927

Cited by 132 publications

(98 citation statements)

References 20 publications

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“…Sometimes the stent may also be a permanent solution, especially in patients with malignant ureteral obstruction; in these cases, encrustations are a major problem, both in terms of patient quality of life and in terms of economic costs. 1,2 The initial step in encrustation of any urinary drainage device appears to be bacterial colonization and the formation of a layer of microorganisms that accumulates on the surface, along with their by-products. 1,3,4,5 The presence of this layer, called "biofilm," in combination with elevation of urinary pH and changes in electrolyte composition, is responsible for crystal formation and stent encrustation.…”

Section: Introduction Umentioning

confidence: 99%

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Cauda

Fiori

et al. 2008

Journal of Endourology

100

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Purpose:To evaluate the ability of heparin coating to inhibit Double J stent encrustation and compare it with the classic polyurethane Double J stent.Patients and Methods: The study involved five patients with bilateral obstructions, who required bilateral ureteral Double J stent placement. Every patient received a heparin-coated Double J stent and a traditional polyurethane Double J stent for 1 month. After removal, the stents were analyzed using field emission scanning electron microscopy (FESEM), energy dispersive spectroscopy (EDS). and micro-infrared spectrophotometry (Micro-IR). These same techniques were used to analyze the heparin-coated and uncoated stents before insertion. The thickness, extension, and composition of encrustation of the coated and uncoated stents were compared. Moreover, two heparin-coated stents were analyzed with the same techniques after they had been in place for 10 and 12 months.Results: FESEM analysis showed that the difference in encrustation thickness and extension between the two groups was significant. EDS and Micro-IR confirmed that in the heparinized stents the encrustations were not as uniform and compact as those in the uncoated stents. The stents that were left in place long-term were free of encrustations and had no changes in the heparin layer.Conclusions: Heparin coating reduces stent encrustation. Moreover, as no changes were seen in the heparin layer, we concluded that covalent heparin bonding enhances its adhesion to the polyurethane surface and ensures its stability for long periods. The heparin-coated stent appears to be a useful tool for long-term urinary drainage.

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Section: Introduction Umentioning

confidence: 99%

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Cauda

Fiori

et al. 2008

Journal of Endourology

100

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“…Similar to transurethral catheters, these devices are subject to biofilm development and asymptomatic www.intechopen.com bacteriuria (Riedl et al, 1999). Often it is difficult to differentiate between asymptomatic bacteriuria and bladder infection, as patients frequently report dysuria, frequency and urgency as a reaction to the indwelling ureteral stent.…”

Section: Other Indwelling Devicesmentioning

confidence: 99%

“…Often it is difficult to differentiate between asymptomatic bacteriuria and bladder infection, as patients frequently report dysuria, frequency and urgency as a reaction to the indwelling ureteral stent. Studies have shown that prophylactic antibiotic treatment did not reduce bacterial colonization or prevent stent obstruction (Riedl et al, 1999). The evidence for screening and treatment in this setting is sparse and therefore not recommended.…”

Section: Other Indwelling Devicesmentioning

confidence: 99%

Asymptomatic Bacteriuria: Significance for Different Patient Population

Nelius¹,

Filleur²,

Nelson³

2011

Urinary Tract Infections

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“…Prolonged encrustation may lead stent fracture, obstruction of the stent lumen and renal unit, urosepsis, and even loss of renal function. 1,2 Kidney stone patients, the most likely population requiring ureteral stents, have been shown to be at the highest risk for encrustation, sometimes occurring within days of stent placement. [1][2][3][4] In spite of advances in biomaterials and surface coatings, no stent completely resists biofilm formation and encrustation because of a complex protein adsorption cascade that occurs along the stent surface within minutes of implantation.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Kidney stone patients, the most likely population requiring ureteral stents, have been shown to be at the highest risk for encrustation, sometimes occurring within days of stent placement. [1][2][3][4] In spite of advances in biomaterials and surface coatings, no stent completely resists biofilm formation and encrustation because of a complex protein adsorption cascade that occurs along the stent surface within minutes of implantation. [5][6][7] The first monolayer of biological molecules that absorb onto any medical device within the human body is called the ''conditioning film.''…”

Section: Introductionmentioning

confidence: 99%

Presence of Five Conditioning Film Proteins Are Highly Associated with Early Stent Encrustation

Canales

Higgins

Markowski

et al. 2009

Journal of Endourology

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Purpose: Ureteral stents are susceptible to biofilm formation and crystal deposition, especially in stone formers. To identify proteins responsible for this accumulation, we compared conditioning film proteomes obtained from human ureteral stents with and without encrustation. Materials and Methods: Twenty-seven Bard InlayÔ hydrophilic ureteral stents were removed after ureteroscopy. Stent encrustation was quantified by visual analog score 0 (none) to 4 (heavy) and further categorized as nonencrusted (scores 0 and 1; n ¼ 22) or encrusted (scores 2, 3, and 4; n ¼ 5). Stent conditioning film was sampled and digested with trypsin, and peptide tandem mass spectrometry data were acquired using liquid chromatography. After protein identification, unconditional exact tests were used to compare categorical variables versus encrustation outcome. Stone analysis and follow-up metabolic urine profiles were examined to identify additional risk factors for stent encrustation. Results: More than 300 unique proteins with >95% confidence were identified. Proteins a-1 anti-trypsin, Ig kappa, IgH G1, and histone H2b and H3a were found to be highly associated with stent encrustation ( p < 0.05), while Tamm-Horsfall protein and histone H2a were found to have a marginal association ( p < 0.1). Patients with early stent encrustation were more likely to have mixed stone analysis ( p ¼ 0.03) and low urinary volumes ( p < 0.01). Conclusion: Immunoglobulins and Tamm-Horsfall protein are common urinary proteins that appear to nonselectively bind early onto ureteral stent surfaces. Histones, nuclear DNA-condensing proteins, likely contribute to stent encrustation because of their unique net positive charge and may represent a potential clinical target for encrustation prevention.

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Bacterial Colonization of Ureteral Stents

Cited by 132 publications

References 20 publications

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Asymptomatic Bacteriuria: Significance for Different Patient Population

Presence of Five Conditioning Film Proteins Are Highly Associated with Early Stent Encrustation

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