Chemical and Mineralogical Analysis of Ureteral Stent Encrustation and Associated Risk Factors

Sighinolfi, Maria Chiara; Sighinolfi, G. P.; Galli, Ermanno; Micali, Salvatore; Ferrari, N.; Mofferdin, A.; Bianchi, Giampaolo

doi:10.1016/j.urology.2015.05.015

Cited by 38 publications

(38 citation statements)

References 17 publications

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“…Biofilm on ureteral stents has been shown to promote encrustation by attracting and incorporating crystals on its surface. However, in the absence of significant pH changes associated with this non-urease colonization, stone deposition is driven by the same factors associated with nephrolithiasis, such as hypocitraturia, hypercalciuria, and hyperoxaluria, and stones are more often composed of calcium oxalate [11, 13]. …”

Section: Discussionmentioning

confidence: 99%

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Minimal Device Encrustation on Vesair Intravesical Balloons in the Treatment of Stress Urinary Incontinence: Analysis of Balloons Removed from Women in the SOLECT Trial

et al. 2017

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IntroductionEncrustation of urinary biomaterials is common; however, the incidence of surface deposition on the Vesair® intravesical pressure-attenuation balloon has not been previously reported. The purpose of this analysis is to determine the incidence and potential risk factors for encrustation of the Vesair intravesical balloon.MethodsThe SOLECT trial is a prospective randomized controlled trial conducted at several European centers to evaluate the safety and efficacy of the Vesair balloon for the treatment of female stress urinary incontinence (SUI). Women included in the study demonstrated SUI symptoms for more than 12 months without complicating factors, such as history of recurrent urinary tract infections or nephrolithiasis. All balloons removed from women enrolled in the SOLECT trial were analyzed for surface characteristics and encrustation. Surface deposition severity was quantified and composition analyzed with infrared spectroscopy and scanning electron microscopy. Incidence of surface deposition was tabulated and risk factors analyzed.ResultsOne hundred and five balloons removed from 75 women were included in this analysis. Measurable stone deposition of less than 1.5 mm was found on four balloons (3.8%), surface granules were noted on 42 (40.0%), surface film on 11 (10.5%), and both granules and film on two (1.9%). Analysis identified calcium oxalate both in measurable encrustation deposits as well as those with surface granulation. Pooled analysis found that dwell time was a risk factor for calcium deposition.ConclusionThe rate of encrustation on the Vesair intravesical balloon is low and does not appear to increase the rate of adverse outcomes or reduce clinical efficacy.FundingSolace Therapeutics, Inc.

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Section: Discussionmentioning

confidence: 99%

“…Sighinolfi and associates suggested different etiologies for stone deposition on the proximal versus distal coil of ureteral stents [13]. On the distal coil, a location more similar to that of the Vesair balloon, the presence of a UTI and advanced patient age contributed to stone formation.…”

Section: Discussionmentioning

confidence: 99%

Minimal Device Encrustation on Vesair Intravesical Balloons in the Treatment of Stress Urinary Incontinence: Analysis of Balloons Removed from Women in the SOLECT Trial

et al. 2017

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“…Urease producing bacteria in the biofilm and lithogenic characteristics of urine in stone formers seem to be the most likely culprits influencing encrustation of the stent surface [47] , [48] ( Fig. 1 ).…”

Section: Stent-related Complicationsmentioning

confidence: 99%

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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“…A prolonged indwell time of stents, as well as a history of nephrolithiasis and urinary infections may result in encrustation of ureteral stents, and will lead to the use of endourological techniques, extracorporeal lithotripsy or open surgery to resolve these conditions (6)(7)(8) Film-formation is a multistep process; shortly after the stent insertion, different organic molecules adhere to its surface forming conditioning film (9,10) and the presence of bacteria attached to the stent surface was considered essential for the formation of struvite and hydroxyapatite crystals (4,11).…”

Section: Introductionmentioning

confidence: 99%

Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a m ulticenter, placebo controlled, double blind, randomized clinical trial

Torrecilla

Fernández-Concha

Cansino

et al. 2020

Preprint

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Background: Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. Participants, design and intervention: A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. Outcome measurements and statistical analysis: The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 – none; 3 – global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. Results: The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p < 0.018). Mean encrustation score was 85.12 (274.5) in the intervention group and 18.91 (102.27) in the placebo group (p < 0.025). Considering the secondary end points, treated patients reported greater urine pH decreases (p = 0.002). No differences in the incidence of adverse events were identified between the groups. Conclusions: Our data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation. Trial registration: This trial was registered at www.clinicaltrials.gov under the name “Combined Use of a Medical Device and a Dietary Complement in Patient Urinary pH Control in Patients With an Implanted Double J Stent” with date 2 nd November 2017, code NCT03343275, and URL: https://clinicaltrials.gov/ct2/show/record/NCT03343275?term=NCT03343275&draw=2&rank=1 Keywords: double J stent; encrustation; nutraceutical; L-methionine; phytin; pH.

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Chemical and Mineralogical Analysis of Ureteral Stent Encrustation and Associated Risk Factors

Cited by 38 publications

References 17 publications

Minimal Device Encrustation on Vesair Intravesical Balloons in the Treatment of Stress Urinary Incontinence: Analysis of Balloons Removed from Women in the SOLECT Trial

Minimal Device Encrustation on Vesair Intravesical Balloons in the Treatment of Stress Urinary Incontinence: Analysis of Balloons Removed from Women in the SOLECT Trial

Ureteral stents in urolithiasis

Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a m ulticenter, placebo controlled, double blind, randomized clinical trial

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