Drug-delivering devices in the urinary tract: A systematic review

Abstract

Objective: : To systematically review the use of drug-eluting stents (DES) and drug-coated balloons (DCB) in urology. Materials and Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Scopus, Web of science and Cochrane Library online databases were searched in February 2019. Experimental and clinical studies, which included the placement of a DES or dilatation with DCB for investigating their potential use in the urinary tract for the management of ureteric or urethral pathologies, were included. The primary endpoint was to evaluate the current use of DES and DCB in urology. Results: A total of 29 articles were included in the systematic review. A total of 10 studies tested DES or DCB containing anti-proliferative agents (paclitaxel, zotarolimus, sirolimus, halofugione). Antibiotic agent-containing DES were tested in nine studies (triclosan, quinolones, teicoplanin, nitrofurantoin, silver sulfadiazine). A total of eight studies investigated the release of anti-inflammatory agents by DES (ketorolac, indomethacin, EW-7197). Another group studied heparin-eluting stents. Conclusion: Despite the inconclusive outcomes of the three randomised controlled trials, drug-coated/eluting devices constitute a promising field in urology for the prevention of complications associated with conventional stents including pain and encrustation. Preclinical in vitro and in vivo studies have shown their ability to mitigate inflammation, inhibit restenosis and improve pain as indicated by declined use of anti-inflammatory drugs.

Nasolacrimal Duct Coronary Stent Recanalization (NCR): First Cadaver Experience and Its Potential as an Alternative to DCR

“…Sirolimus-eluting stents have been extensively used in coronary and peripheral vascular disease and have shown promise as urinary tract stents. 17,23,24…”

“…Sirolimus-eluting stents have been extensively used in coronary and peripheral vascular disease and have shown promise as urinary tract stents. 17,23,24 The coronary stent used in the present study had a coating of biodegradable Resomer and shellac resin mixed with sirolimus. The abluminal surface of the stent has the coating, and nominal dosages of sirolimus vary with the diameter and length of the stent.…”

Stenting of Malignant Urinary Tract Obstructions in Humans and Companion Animals

“…Extraluminal ureteral compression can also occur from masses or lymphadenomegaly. Lastly, after radiation therapy in the region of the ureter, ureteral obstruction can result from fibrosis-induced stricture or alteration of ureteral elasticity with subsequent decreased peristaltic activity [4,5,21].…”

“…Complications of ureteral stenting may include ureteral or vascular injury, local tissue reaction to the stent with subsequent tissue overgrowth, vesicorenal reflux, stent encrustation, pyelonephritis, bladder irritation, migration, and compression resulting in reobstruction [1,3,21]. Technical success (often defined as placement of the stents using an interventional technique) is generally considered very high, with most percentages being >94% in humans [2,3].…”

“…This concept has also been investigated for use with ureteral and urethral stents as well. These can include drug-eluting stents which release these agents locally in a controlled manner or drug-coated stents, which are covered with pharmaceutical agents that provide additional characteristics to the stent [21]. The pharmaceutical agents that have been most investigated include antibiotics, anti-inflammatories, and anti-proliferative agents such as paclitaxel [21].…”