Skip to main content

Advertisement

SpringerLink
Log in

Current Status of Ureteral Stent Technologies: Comfort and Antimicrobial Resistance

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

The placement of a ureteral stent is one of the most commonly performed urologic procedures. Indwelling ureteral stents are often accompanied by significant patient morbidity, including lower urinary tract symptoms, flank pain, and urinary tract infections. This article reviews the current state of ureteral stent technology developed to address the problem of stent discomfort and infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of Importance

  1. Joshi HB, Stainthorpe A, Keeley FX Jr, et al.: Indwelling ureteral stents: evaluation of quality of life to aid outcome analysis. J Endourol 2001, 15:151–154.

    Article  CAS  PubMed  Google Scholar 

  2. Leibovici D, Cooper A, Lindner A, et al.: Ureteral stents: morbidity and impact on quality of life. Isr Med Assoc J 2005, 7:491–494.

    PubMed  Google Scholar 

  3. Lennon GM, Thornhill JA, Sweeney PA, et al.: ‘Firm’ versus ‘soft’ double pigtail ureteric stents: a randomised blind comparative trial. Eur Urol 1995, 28:1–5.

    CAS  PubMed  Google Scholar 

  4. Joshi HB, Chitale SV, Nagarajan M, et al.: A prospective randomized single-blind comparison of ureteral stents composed of firm and soft polymer. J Urol 2005, 174:2303–2306.

    Article  CAS  PubMed  Google Scholar 

  5. Pryor JL, Langley MJ, Jenkins AD: Comparison of symptom characteristics of indwelling ureteral catheters. J Urol 1991, 145:719–722.

    CAS  PubMed  Google Scholar 

  6. Lee C, Kuskowski M, Premoli J, et al.: Randomized evaluation of ureteral stents using validated symptom questionnaire. J Endourol 2005, 19:990–993.

    Article  PubMed  Google Scholar 

  7. Lingeman JE, Preminger GM, Goldfischer ER, Krambeck AE; Comfort Study Team: Assessing the impact of ureteral stent design on patient comfort. J Urol 2009, 181:2581–2587.

    Article  PubMed  Google Scholar 

  8. Dunn MD, Portis AJ, Kahn SA, et al.: Clinical effectiveness of new stent design: randomized single-blind comparison of tail and double-pigtail stents. J Endourol. 2000, 14:195–202

    Google Scholar 

  9. Lumiaho J, Heino A, Kauppinen T, et al.: Drainage and antireflux characteristics of a biodegradable self-reinforced, self-expanding X-ray-positive poly-L,D-lactide spiral partial ureteral stent: an experimental study. J Endourol 2007, 21:1559–1564.

    Article  PubMed  Google Scholar 

  10. Erturk E, Sessions A, Joseph JV: Impact of ureteral stent diameter on symptoms and tolerability. J Endourol 2003, 17:59–62.

    Article  PubMed  Google Scholar 

  11. Chandhoke PS, Barqawi AZ, Wernecke C, Chee-Awai RA: A randomized outcomes trial of ureteral stents for extracorporeal shock wave lithotripsy of solitary kidney or proximal ureteral stones. J Urol 2002, 167:1981–1983.

    Article  PubMed  Google Scholar 

  12. Damiano R, Autorino R, De Sio M, et al.: Does the size of ureteral stent impact urinary symptoms and quality of life? A prospective randomized study. Eur Urol 2005, 48:673–678.

    Article  PubMed  Google Scholar 

  13. Al-Kandari AM, Al-Shaiji TF, Shaaban H, et al.: Effects of proximal and distal ends of double-J ureteral stent position on postprocedural symptoms and quality of life: a randomized clinical trial. J Endourol 2007, 21:698–702.

    Article  PubMed  Google Scholar 

  14. El-Nahas AR, El-Assmy AM, Shoma AM, et al.: Self-retaining ureteral stents: analysis of factors responsible for patients’ discomfort. J Endourol 2006, 20:33–37.

    Article  PubMed  Google Scholar 

  15. Rane A, Saleemi A, Cahill D, et al.: Have stent-related symptoms anything to do with placement technique? J Endourol 2001, 15:741–745.

    Article  CAS  PubMed  Google Scholar 

  16. Norris RD, Sur RL, Springhart WP, et al.: A prospective, randomized, double- blinded placebo-controlled comparison of extended release oxybutynin versus phenazopyridine for the management of postoperative ureteral stent discomfort. Urology 2008, 71:792–795.

    Article  PubMed  Google Scholar 

  17. Beddingfield R, Pedro RN, Hinck B, et al.: Alfuzosin to relieve ureteral stent discomfort: a prospective, randomized, placebo controlled study. J Urol 2009, 181:170–176.

    Article  PubMed  Google Scholar 

  18. Deliveliotis C, Chrisofos M, Gougousis E, et al.: Is there a role for alpha1- blockers in treating double-J stent-related symptoms? Urology 2006, 67:35–39.

    Article  PubMed  Google Scholar 

  19. Damiano R, Autorino R, De Sio M, et al.: Effect of tamsulosin in preventing ureteral stent-related morbidity: a prospective study. J Endourol 2008, 22:651–656.

    Article  PubMed  Google Scholar 

  20. • Wang CJ, Huang SW, Chang CH: Effects of specific alpha-1A/1D blocker on lower urinary tract symptoms due to double-J stent: a prospectively randomized study. Urol Res 2009, 37:147–152. This solid and large randomized clinical trial shows the effect of a superselective α- blocker for stent-related symptoms.

  21. Beiko DT, Watterson JD, Knudsen BE, et al.: Double-blind randomized controlled trial assessing the safety and efficacy of intravesical agents for ureteral stent symptoms after extracorporeal shockwave lithotripsy. J Endourol 2004, 18:723–730.

    PubMed  Google Scholar 

  22. Sur RL, Haleblian GE, Cantor DA, et al.: Efficacy of intravesical ropivacaine injection on urinary symptoms following ureteral stenting: a randomized, controlled study. J Endourol 2008, 22:473–478.

    Article  PubMed  Google Scholar 

  23. Chew B, Davoudi H, Li J, Denstedt JD: An in vivo porcine evaluation of the safety, bioavailability and tissue penetration of ketorolac drug eluting ureteral stent designed to improve comfort. J Endourol 2009 (in press).

  24. Krambeck AM, Walsh RS, Denstedt JD, et al.: A novel drug eluting stent: a prospective, randomized, multicenter clinical trial to evaluate the safety and effectiveness of a ketorolac loaded ureteral stent. J Urol 2009 (in press).

  25. Paz A, Amiel GE, Pick N, et al.: Febrile complications following insertion of 100 double-J ureteral stents. J Endourol 2005, 19:147–150.

    Article  PubMed  Google Scholar 

  26. Costerton JW, Cheng KJ, Geesey GG, et al.: Bacterial biofilm in nature and disease. Ann Rev Microbiol 1987, 41:435–464.

    Article  CAS  Google Scholar 

  27. Reid G, Sobel JD: Bacterial adherence in the pathogenesis of urinary tract infection: a review. Rev Infect Dis 1987, 9:470–487.

    CAS  PubMed  Google Scholar 

  28. Riedl CR, Plas E, Hubner W, et al.: Bacterial colonization of ureteral stents. Eur Urol 1999, 36:53–59.

    Article  CAS  PubMed  Google Scholar 

  29. Akai F, Aflay U, Gedik A, et al.: Risk factors for lower urinary tract infection and bacterial stent colonization in patients with a double J ureteral stent. Int Urol Nephrol 2007, 39:95–98.

    Article  Google Scholar 

  30. Klis R, Korczak-Kozakiewicz E, Denys A, et al.: Relationship between urinary tract infection and self-retaining double J catheter colonization. J Urol 2009, 23:1015–1019.

    Google Scholar 

  31. Lojanapiwat B: Colonization of internal ureteral stent and bacteriuria. World J Urol 2006, 24:681–683.

    Article  CAS  PubMed  Google Scholar 

  32. Connell I, Agace W, Klemm P, et al.: Type I fimbrial expression enhances Escherichia coli virulence for the urinary tract. Proc Natl Acad Sci U S A 1996, 93:9827–9832.

    Article  CAS  PubMed  Google Scholar 

  33. Santin M, Motta A, Denyer SP, Cannas M: Effect of the urine conditioning film on ureteral stent encrustation and characterization of its protein composition. Biomaterials 1999, 20:1245–1251.

    Article  CAS  PubMed  Google Scholar 

  34. Denstedt JD, Reid G, Sofer M: Advances in ureteral stent technology. World J Urol 2000, 18:237–242.

    Article  CAS  PubMed  Google Scholar 

  35. Reid G, Tieszer C, Denstedt JD, Kingston D: Examination of bacterial and encrustation deposition on ureteral stents of differing surface properties, after indwelling in humans. Coll Surf B Biointerfaces 1995, 5:171–179.

    Article  CAS  Google Scholar 

  36. Reid G, Busscher HJ: Importance of surface properties in bacterial adhesion to biomaterials, with particular reference to the urinary tract. Int Biodeter Biodegrad 1992, 30:105–122.

    Article  Google Scholar 

  37. Gristina AG: Biomaterial-centered infection: microbial adhesion versus tissue integration. Science 1987, 237:1588–1595.

    Article  CAS  PubMed  Google Scholar 

  38. Characklis WG, Marshall KC: Biofilms: a basis for interdisciplinary approach. In Biofilms. Edited by Characklis WG, Marshall KC. New York: John Wiley and Sons;1990:3–15.

    Google Scholar 

  39. Reid G, Busscher HJ: Microbial biofilms and urinary tract infections. Urinary tract infections. London: Chapman and Hall; 1998:111–118.

    Google Scholar 

  40. • Stickler DJ: Bacterial biofilms in patients with indwelling urinary catheters. Nat Clin Pract 2008, 5:598–608. This is a comprehensive review of the mechanisms of biofilm formation.

    Google Scholar 

  41. Salo J, Devancer JJ, Tapiainen T, et al.: Biofilm formation by Escherichia coli isolated from patients with urinary tract infections. Clin Nephrol 2009, 71:501–507.

    CAS  PubMed  Google Scholar 

  42. Hasan F, Xess I, Wang X, et al.: Biofilm formation in clinical Candida isolates and its association with virulence. Microbes Infect 2009, 11:753–761.

    Article  CAS  PubMed  Google Scholar 

  43. Raad R, Darouiche J, Dupuis D, et al.: Central venous catheters coated with minocycline and rifampin for the prevention of catheter related colonization and bloodstream infections. Ann Intern Med 1997, 127:267–274.

    CAS  PubMed  Google Scholar 

  44. Cadieux PA, Chew B, Nott L, et al.: Use of triclosan-eluting ureteral stents in patients with long-term stents. J Endourol 2009, 23:1187–1188.

    Article  PubMed  Google Scholar 

  45. Cadieux PA, Chew BH, Knudsen BE, et al.: Triclosan loaded ureteral stents decrease Proteus mirabilis 296 infection in a rabbit urinary tract infection model. J Urol 2006, 175:2331.

    Article  PubMed  Google Scholar 

  46. Chew BH, Cadieux PA, Reid G, et al.: In-vitro activity of triclosan-eluting ureteral stents against common bacterial uropathogens. J Endourol 2006, 20:949.

    Article  PubMed  Google Scholar 

  47. Elwood CN, Chew BH, Seney S, et al.: Triclosan inhibits uropathogenic Escherichia coli-stimulated tumor necrosis factor-α secretion in T24 bladder cells in vitro. J Endourol 2007, 21:1217–1222.

    Article  PubMed  Google Scholar 

  48. Angell AH, Resnick MI: Surface interaction between glycosaminoglycans and calcium oxalate. J Urol 1989, 141:1255.

    CAS  PubMed  Google Scholar 

  49. Appelgren P, Ransjo U, Bindslev L, et al.: Surface heparinization of central venous catheters reduces microbial colonization in vitro and in vivo: results from a prospective, randomized trial. Crit Care Med 1996, 24:1482.

    Article  CAS  PubMed  Google Scholar 

  50. Lange D, Elwood C, Choi K, et al.: Uropathogen interaction with the surface of urological stents using different surface properties. J Urol 2009, 182:1194–1200.

    Article  PubMed  Google Scholar 

  51. Cauda F, Cauda V, Fiori C, et al.: Heparin coating on ureteral double J stents prevents encrustations: an in vivo case study. J Endourol 2008, 22:465–472.

    Article  PubMed  Google Scholar 

  52. Hancock RE, Scott MG: The role of antimicrobial peptides in animal defenses. Proc Natl Acad Sci U S A 2000, 97:8856–8861.

    Article  CAS  PubMed  Google Scholar 

  53. Minardi D, Ghiselli R, Cirioni O, et al.: The antimicrobial tachyplesin III coated alone and in combination with intraperitoneal piperacillin-tazobactam prevents ureteral stent Pseudomonas infection in a rat subcutaneous pouch model. Peptides 2007, 28:2293–2298.

    Article  CAS  PubMed  Google Scholar 

  54. Balaban N, Gov Y, Bitler A, Boelaert JR: Prevention of staphylococcus aureus biofilm on dialysis catheters and adherence to human cells. Kidney Int 2003, 63:340–345.

    Article  PubMed  Google Scholar 

  55. Cirioni O, Ghiselli R, Minardi D, et al.: RNAIII-Inhibiting peptide affects biofilm formation in a rat model of staphylococcal ureteral stent infection. Antimicrob Agents Chemother 2007, 51:4518–4520.

    Article  CAS  PubMed  Google Scholar 

  56. Laube N, Kleinen L, Bradenhal J, Meissner A: Diamond-like carbon coatings on ureteral stents: a new strategy for decreasing the formation of crystalline bacterial biofilms?. J Urol 2007, 177:1923–1927.

    Article  CAS  PubMed  Google Scholar 

  57. Denstedt JD, Cadieux PA: Eliminating biofilm from ureteric stents: the holy grail. Curr Op Urol 2009, 19:205–210.

    Article  Google Scholar 

Download references

Disclosure

Dr. John D. Denstedt is a consultant for Boston Scientific. No other potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Schulich School of Medicine and Dentistry, The University of Western Ontario, 268, Grosvenor Street, London, ON, N6A 4V2, Canada

    Carlos E. Mendez-Probst, Alfonso Fernandez & John D. Denstedt

Authors
  1. Carlos E. Mendez-Probst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alfonso Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John D. Denstedt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John D. Denstedt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mendez-Probst, C.E., Fernandez, A. & Denstedt, J.D. Current Status of Ureteral Stent Technologies: Comfort and Antimicrobial Resistance. Curr Urol Rep 11, 67–73 (2010). https://doi.org/10.1007/s11934-010-0091-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-010-0091-y

Keywords

Search

Navigation