Characterization of biofilm and encrustation on ureteric stents <i>in vivo</i>

Keane, Patrick F.; Bonner, Michael; Johnston, S. R.; Zafar, Atif; Gorman, Seán

doi:10.1111/j.1464-410x.1994.tb07557.x

Cited by 144 publications

(94 citation statements)

References 7 publications

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“…This elevates urinary pH, favoring the precipitation of magnesium and calcium as struvite and hydroxyl apatite (17,18). Although the exact mechanism of encrustation in sterile urine is unclear, it appears to be dependent on the pH, ionic strength and biomaterial hydrophobic properties (19). The degree of encrustation is dependant on the dwelling time.…”

Section: Commentsmentioning

confidence: 99%

Endourological Management of Forgotten Encrusted Ureteral Stents

2010

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Purpose: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. Materials and Methods: From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. Results: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. Conclusion: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

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Section: Commentsmentioning

confidence: 99%

Endourological Management of Forgotten Encrusted Ureteral Stents

2010

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“…Encrustation plays a signi®cant role in the complications from and morbidity of urological devices [1,2].…”

Section: Introductionmentioning

confidence: 99%

A model to quantify encrustation on ureteric stents, urethral catheters and polymers intended for urological use

Choong¹,

Wood²,

Whitfield³

2000

BJU International

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Objective To validate an encrustation model and to quantify encrustation on currently used urological devices and polymers intended for urological use. Materials and methods An encrustation model was validated: (i) to measure the amount of calcium leaching from the glass model and from the polymer used; (ii) to determine whether the use of a singlesource or pooled urine produced similar results; (iii) to determine in vitro encrustation; and (iv) to compare the results of in vivo implantation of the same materials into the bladders of rodents with the in vitro results. A test polymer (a ureteric stent, a urethral catheter or a biomaterial) and a control silicone polymer were housed separately but received human urine from the same reservoir and under the same conditions (pH 6.0 and 37uC) for 5 days. The amount of calcium encrustation on each polymer was measured using atomic absorption spectroscopy. Each experiment was repeated at least four times and the results expressed as an encrustation index, de®ned as the ratio of encrustation of the test and reference polymers.Results The amount of calcium leaching from the glass model and polymers tested was insigni®cant. The use of a single-source or pooled urine gave the same results in the encrustation model. The in vitro results correlated with in vivo implantation of disks into the bladders of rats. Among the commonly used ureteric stents tested, the Cook C-Flex ureteric stents encrusted least. Hydrogel-coated ureteric stents encrusted more than uncoated stents. The Bard polytetra¯uoroethy-lene short-term urethral catheter encrusted more than the Bard hydrogel-coated long-term catheter. A plasma-activated surface modi®cation of a synthetic biomaterial with hyaluronic acid encrusted less than silicone, a long-term biomaterial widely regarded as the`gold standard'. Conclusion This validated encrustation model is the ®rst to quantify encrustation on currently available ureteric stents and urethral catheters. A novel coating for a biomaterial was identi®ed using the encrustation model, and which encrusted less than silicone.

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“…These studies have shown that ureteric stents are colonized by Gram-positive cocci more freinhibited the adherence of both strains, probably because both strains were sensitive to ciprofloxacin, suggesting quently than by Gram-negative bacteria [14,15], suggesting urethral contamination and therefore supporting that ciprofloxacin was able to adhere to the items. However, the antibacterial activity of the items with the hypothesis that internal urinary prostheses are unlikely to come in contact with bacteria after their absorbed ciprofloxacin decreased after incubation in saline.…”

Section: Methodsmentioning

confidence: 99%

Immersion in antibiotic solution prevents bacterial adhesion onto biodegradable prostatic stents

Cormio

Forgia

Siitonen

et al. 1997

British Journal of Urology

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Objective To determine whether immersion in antibiotic solution reduces or prevents bacterial adhesion onto biodegradable prostatic stents. Materials and methods Pre‐cut segments of polyglycolic acid (PGA) and polylactic acid (PLA) prostatic stents were incubated with two common uropathogenic bacterial strains (Enterococcus faecalis and Escherichia coli) with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used, as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI). Results Immersion in ciprofloxacin solution prevented the adherence of both bacterial strains. Immersion in ceftriaxone solution prevented only the adherence of the E. coli strain. Immersion in tobramycin solution had no effect on either of the strains. The stent materials per se did not influence bacterial adhesion. After immersion in ciprofloxacin, the stent segments retained significant antibacterial activity even after one day's incubation in saline. Conclusion Immersion in a suitable antibiotic solution may significantly reduce and even prevent bacterial adhesion onto biodegradable prostatic stents. Preventing bacterial adhesion may reduce the risk of UTI during the use of these devices.

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Characterization of biofilm and encrustation on ureteric stents in vivo

Abstract: The results indicate that polyurethane is readily encrusted and colonized by bacteria in vivo despite antibiotic prophylaxis. Newer materials must be sought if effective long-term stenting is to be achieved.

Cited by 144 publications

References 7 publications

Endourological Management of Forgotten Encrusted Ureteral Stents

Endourological Management of Forgotten Encrusted Ureteral Stents

A model to quantify encrustation on ureteric stents, urethral catheters and polymers intended for urological use

Immersion in antibiotic solution prevents bacterial adhesion onto biodegradable prostatic stents

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