1450: Double J Stent with Synthetic Heparin Coating does not Prevent Biofilm Deposit and Mineral Incrustation in Comparison with Standard Double J Stent

Abstract INTRODUCTION The aim of this study is to assess the effectiveness of heparin to inhibit the development of early bacteriuria as a coating for biodegradable ureteral stents. MATERIAL AND METHODS The BraidStent®-H biodegradable stent, whose heparin coating is incorporated by dip coating, was chosen for this study. Twenty-four swine were randomly divided into two groups: 12 animals underwent unilateral placement of the BraidStent®-H and 12 were fitted with a standard double-j stent (DJS). Bacteriuria is comparatively analyzed over time by consecutive urine sampling at 0, 1, 3, 6, 12, 24 and 48 hours. In addition, the concentration of heparin released in vitro in artificial urine at 0, 3, 6, 12, 24, 48, 72, 92 and 120 hours is determined via ELISA. RESULTS BraidStent®-H generates a significantly lower bacteriuria rate than a DJS at 6 and 12 hours. Heparin coating shows a significant delaying effect on the onset of bacteriuria, reaching 100% of the animals at 48 hours, compared to the DJS, which takes place at 6 hours. ELISA results reveal the presence of heparin in urine for a total of 72 hours. The coating does not affect the degradation of the device, which is completed at 6 weeks. CONCLUSIONS Heparin evidences an effective inhibition of early bacteriuria, showing its potential as an antibacterial coating for biodegradable ureteral stents. Future studies should focus on the development of long-term heparin coatings for biodegradable materials.

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Antithrombin III Binding to Surface Immobilized Heparin and Its Relation to F Xa Inhibition

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646057 ◽

1987 ◽

Vol 58 (04) ◽

pp. 1064-1067 ◽

Cited By ~ 41

Author(s):

K Kodama ◽

B Pasche ◽

P Olsson ◽

J Swedenborg ◽

L Adolfsson ◽

...

Keyword(s):

Molecular Weight ◽

Ionic Strength ◽

Surface Coating ◽

Antithrombin Iii ◽

Lower Class ◽

Biologically Active ◽

High Affinity ◽

Heparin Coating ◽

Continuous Surface ◽

Approximate Molecular Weight

SummaryThe mode of F Xa inhibition was investigated on a thromboresistant surface with end-point attached partially depoly-merized heparin of an approximate molecular weight of 8000. Affinity chromatography revealed that one fourth of the heparin used in surface coating had high affinity for antithrombin III (AT). The heparin surface adsorbed AT from both human plasma and solutions of purified AT. By increasing the ionic strength in the AT solution the existence of high and low affinity sites could be shown. The uptake of AT was measured and the density of available high and low affinity sites was found to be in the range of 5 HTid 11 pic.omoles/cmf, respectively Thus the estimated density of biologically active high and low ailmity heparm respectively would be 40 and 90 ng/cm2 The heparin coating did not take up or exert F Xa inhibition by itself. With AT adsorbed on both high and low affinity heparin the surface had the capacity to inhibit several consecutive aliquots of F Xa exposed to the surface. When mainly high affinity sites were saturated with AT the inhibition capacity was considerably lower. Tt was demonstrated that the density of AT on both high and low affinity heparin determines the F Xa inhibition capacity whereas the amount of AT on high affinity sites limits the rate of the reaction. This implies that during the inhibition of F Xa there is a continuous surface-diffusion of AT from sites of a lower class to the high affinity sites where the F Xa/AT complex is formed and leaves the surface. The ability of the immobilized heparin to catalyze inhibition of F Xa is likely to be an important component for the thromboresistant properties of a heparin coating with non-compromized AT binding sequences.

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A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report

Case Reports in Medicine ◽

10.1155/2013/236286 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Selcuk Sarikaya ◽

Berkan Resorlu ◽

Ekrem Ozyuvali ◽

Omer Faruk Bozkurt ◽

Ural Oguz ◽

...

Keyword(s):

Ureteral Stone ◽

Ammonium Phosphate ◽

Intravenous Urography ◽

Metabolic Abnormalities ◽

Magnesium Ammonium Phosphate ◽

Distal Ureter ◽

Double J Stent ◽

Magnesium Ammonium ◽

Left Flank Pain ◽

Plain Abdominal Film

A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux.

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An Empirical Study on the Operative Treatment of Symptomatic Urolithiasis in Germany

Urologia Internationalis ◽

10.1159/000510589 ◽

2021 ◽

pp. 1-7

Author(s):

Alina Reicherz ◽

Rüveyde Sahin ◽

Lorine Häuser ◽

Joachim Noldus ◽

Peter Bach

Keyword(s):

Response Rate ◽

Intraoperative Complications ◽

Nationwide Survey ◽

Treatment Modalities ◽

European Guidelines ◽

Operative Care ◽

Double J Stent ◽

Before And After ◽

Related Group ◽

Ureteral Stenting

Purpose: The guidelines of the German, European, and American Urological Associations on urolithiasis advise against general ureteral stenting before and after an uncomplicated ureterorenoscopy (URS). However, German and European guidelines state that stenting prior to URS facilitates stone extraction and reduces intraoperative complications. According to the published literature, German practice seems to deviate from recommendations. This nationwide survey aimed to evaluate the treatment modalities of urolithiasis. Methods: In November 2018 and March 2019, a total of 199 urological hospital departments in Germany were anonymously surveyed about operative care of symptomatic urolithiasis. The response rate was 72.9%. The survey consisted of 25 questions about diagnostics, surgical technique, and aftercare of the URS. This questionnaire is available in the appendix. Results: A primary URS is performed in ≤10% in 49.6% of the hospitals. In every second urological department (49.7%), the German Diagnosis Related Group (G-DRG) system influences the period of pre-stenting before a secondary URS. After a secondary URS, which is performed in 53.8% of the departments in over 80% of the patients, 14% of the departments omit stenting. The standard for stenting seems to be a 28-cm-long 7 Charrière double-J stent in Germany. Conclusion: In Germany, the percentage of primary URS is low, and a ureter stenting is performed in most of the urological departments after URS. Delaying therapy due to economic aspects is the standard in almost half of all urological departments.

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Efficacy of cystone versus tamsulosin in treatment of stent-related lower urinary tract symptoms

Journal of Clinical Urology ◽

10.1177/20514158211000214 ◽

2021 ◽

pp. 205141582110002

Author(s):

Mohammad Ali Ghaed ◽

Reza Rezaei ◽

Amineh Shafeinia ◽

Robab Maghsoudi

Keyword(s):

Urinary Tract ◽

Symptom Score ◽

Lower Urinary Tract Symptoms ◽

International Prostate Symptom Score ◽

Lower Urinary Tract ◽

Visual Analogue Score ◽

Stent Insertion ◽

Double J Stent ◽

Urinary Tract Symptoms ◽

Lower Urinary

Objective: Double-J stent is a common tool used in urological procedures that is inserted for 2–6 weeks, but it may induce abdominal and flank pain, incontinence and irritative urinary symptoms. Alleviation of such symptoms would be useful to improve the patients’ quality of life. Accordingly, in this study, the efficacy of cystone versus tamsulosin in the treatment of double-J stent-related lower urinary tract symptoms was determined. Materials and methods: In this randomised clinical trial, 128 patients who required double-J stent insertion after transureteral lithotripsy during 2018–2019 were enrolled. They were randomly assigned to receive either cystone, tamsulosin, both, or placebo. The international prostate symptom score and visual analogue score data were recorded at baseline, after 2 and 4 weeks across the groups. Results: The international prostate symptom score and visual analogue score factors were statistically different across the case groups receiving cystone, tamsulosin and both drugs versus placebo ( P=0.001). Two weeks after drug administration, the visual analogue score and international prostate symptom score were not statistically different in the tamsulosin, cystone and dual therapy groups; however, after 4 weeks the cystone group had the lowest symptoms. Conclusion: Both tamsulosin and cystone are efficient drugs which would relieve stent-related lower urinary tract symptoms. The administration of cystone with or without tamsulosin for 4 weeks may have the best result in reducing the visual analogue score and international prostate symptom score. Level of evidence: Level I, 1b, therapeutic study, randomised controlled trial

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A comparison of radiographic signs of pulmonary inflammation during ECMO between silicon and poly-methyl pentene oxygenators

Perfusion ◽

10.1177/0267659106075950 ◽

2007 ◽

Vol 22 (1) ◽

pp. 15-21 ◽

Cited By ~ 14

Author(s):

Espeed Khoshbin ◽

Anthony EW Dux ◽

Hilliary Killer ◽

Andrzej W Sosnowski ◽

Richard K Firmin ◽

...

Keyword(s):

Inflammatory Response ◽

Quantitative Methods ◽

Inflammatory Process ◽

Life Support ◽

Extracorporeal Life Support ◽

Pulmonary Inflammation ◽

Delayed Response ◽

Heparin Coating ◽

Percentage Survival ◽

Inflammatory Changes

Introduction: The inflammatory response caused by extracorporeal membrane oxygenation (ECMO) is clearly visible within the first 24 h of cannulation. The inflammatory process affects all areas of the lung, even areas previously spared by the primary disease. Objective: To compare the change in the radiographic signs of inflammatory response to ECMO between poly-methyl pentene and silicon oxygenators. Study design: Retrospective review of neonates and adults pre- and post-replacement of silicon oxygenators with poly-methyl pentene devices. Data were collected from Extracorporeal Life Support Organisation (ELSO) registry forms and patient records. Results were analysed by quantitative and semi-quantitative methods. Results: There was a significant reduction in the radiographic signs of inflammatory response to ECMO, and a reduction in the time taken to revert to pre-ECMO state in the neonatal poly-methyl pentene group compared to silicon. However, there was no significant reduction in the duration of ECMO runs and the percentage survival between these groups in the neonates. In adults, there was no difference in severity of radiographic signs between groups. However, the inflammatory changes were relatively delayed in the adult poly-methyl pentene group. Conclusion: Poly-methyl pentene (Medos) oxygenators have reduced the host's response phenomenon `white out' in neonates, and caused a delayed response in adults. This is most likely a consequence of smaller blood contact surface area combined with the effect of heparin coating of the oxygenator membrane. However, recovery was not a function of the type of gas exchange device used. Perfusion (2007) 22, 15-21.

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