Biofilm formation on ureteral stents - Incidence, clinical impact, and prevention

Zumstein, Valentin; Betschart, Patrick; Albrich, Werner C.; Buhmann, Matthias T.; Ren, Qun; Schmid, Hans‐Peter; Abt, Dominik

doi:10.4414/smw.2017.14408

Cited by 50 publications

(52 citation statements)

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“…The findings discussed in this paper are also in qualitative agreement with clinical studies, demonstrating enhanced presence of biofilms on the outside surface of stents [25], which could be potentially attributed to the presence of obstructions (or strictures) between the ureter and stent.…”

Section: Discussionsupporting

confidence: 88%

“…Ureteral stents are deployed clinically to restore urinary drainage from kidneys to the bladder when drainage is impaired by pathological ureteral occlusions; however, they can suffer from complications, leading to side effects. One of the most recurrent complications is the formation of mineral precipitating biofilms on the surfaces of the stent, possibly causing failure of the stent and urinary tract infection, which might require pharmacological treatment or surgical intervention [25].…”

Section: Discussionmentioning

confidence: 99%

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A Microfluidic-Based Investigation of Bacterial Attachment in Ureteral Stents

et al. 2020

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Obstructions of the ureter lumen can originate from intrinsic or extrinsic factors, such as kidney stones, tumours, or strictures. These can affect the physiological flow of urine from the kidneys to the bladder, potentially causing infection, pain, and kidney failure. To overcome these complications, ureteral stents are often deployed clinically in order to temporarily re-establish urinary flow. Despite their clinical benefits, stents are prone to encrustation and biofilm formation that lead to reduced quality of life for patients; however, the mechanisms underlying the formation of crystalline biofilms in stents are not yet fully understood. In this study, we developed microfluidic-based devices replicating the urodynamic field within different configurations of an occluded and stented ureter. We employed computational fluid dynamic simulations to characterise the flow dynamic field within these models and investigated bacterial attachment (Pseudomonas fluorescens) by means of crystal violet staining and fluorescence microscopy. We identified the presence of hydrodynamic cavities in the vicinity of a ureteric occlusion, which were characterised by low levels of wall shear stress (WSS < 40 mPa), and observed that initiation of bacterial attachment occurred in these specific regions of the stented ureter. Notably, the bacterial coverage area was directly proportional to the number of cavities present in the model. Fluorescence microscopy confirmed that the number density of bacteria was greater within cavities (3 bacteria·mm−2) when compared to side-holes of the stent (1 bacterium·mm−2) or its luminal surface (0.12 bacteria·mm−2). These findings informed the design of a novel technological solution against bacterial attachment, which reduces the extent of cavity flow and increases wall shear stress over the stent’s surface.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

A Microfluidic-Based Investigation of Bacterial Attachment in Ureteral Stents

et al. 2020

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“…The deposition of conditioning film molecules, the first step of biofilm formation, starts almost immediately after stent insertion in the human body [44] . Bacterial colonization was reported in 24% before 4 weeks, 33% after 4–6 weeks and 71% thereafter [43] . Additionally, diabetes mellitus, chronic renal failure and pregnancy were associated with a higher risk of stent related bacteriuria [45] .…”

Section: Stent-related Complicationsmentioning

confidence: 99%

“…Biofilm formation on the stent surface has been implicated as an important step in the process of stent associated UTI, stent encrustation and SRS. Biofilm formation is a multistep process, resulting in a complex, multilayered organized structure composed of organic molecules, fluid-filled spaces and bacteria that adhere to the stent surface [43] . Within this biofilm, microorganisms are protected from host defenses and antibiotics, which may lead to an accelerated development of antibiotic resistance.…”

Section: Stent-related Complicationsmentioning

confidence: 99%

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Ureteral stents in urolithiasis

Beysens

Tailly

2018

Asian Journal of Urology

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Ever since the ureteral stent design was fitted with a curl on both sides to prevent it from migrating up or down the ureter some 40 years ago, its use has gained tremendous momentum, aiding in the rise and evolution of endourology and has confidently kept its place in modern time urology. Over the past four decades, several designs, coating and biomaterials have been developed, trying to reduce infection, encrustation and other stent related symptoms. As the ideal stent has not yet been discovered, different ways of helping patients with their complaints have been researched. This review will cover these aspects of stent use in urolithiasis.

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