Endoscopy-Endourology Department, Jesús Usón Minimally Invasive Surgery Centre Foundation, Carretera N-521, Km. 41.8, C.P.10071, Cáceres, Spain.
Endoscopy-Endourology Department, Jesús Usón Minimally Invasive Surgery Centre Foundation, Cáceres, Spain.
BMC Urol. 2021 Feb 28;21(1):32. doi: 10.1186/s12894-021-00802-x.
Double J ureteral stents are widely used on urological patients to provide drainage of the upper urinary tract. Unfourtunately, ureteral stents are not free from complications, as bacterial colonization and require a second procedure for removal. The purpose of the current comparative experimental study is to evaluate a new heparin-coated biodegradable antireflux ureteral stent (BraidStent®-H) to prevent urinary bacterial colonization.
A total of 24 female pigs were underwent determination of bacteriuria and nephrosonographic, endoscopic and contrast fluoroscopy assessment of the urinary tract. Afterward, were randomly assigned animals to Group-I, in which a 5Fr double-pigtail ureteral stent was placed for 6 weeks, or Group-II, in which a BraidStent®-H was placed. Follow-up assessments were performed at 1, 3, 6, 8, 12 weeks. The final follow-up includes the above methods and an exhaustive pathological study of the urinary tract was accomplished after 20 weeks.
Bacteriuria findings in the first 48 h were significant between groups at 6 h and 12 h. Asymptomatic bacteriuria does not reach 100% of the animals in Group-II until 48 h versus Group-I where it appears at 6 h. The weekly bacteriuria mean rate was 27.7% and 44.4% in Group I and II respectively, without statistical significance. In Group II there were no animals with vesicoureteral reflux, with statistical significance at 3 and 6 weeks with Group-I. The 91.2% of stents in Group-II were degraded between 3 and 6 weeks, without obstructive fragments. Distal ureteral peristalsis was maintained in 66.6-75% in Group-II at 1-6 weeks.
The heparin coating of BraidStent® allows an early decrease of bacterial colonization, but its effectiveness is low at the long term. Heparin coating did not affect scheduled degradation rate or size of stents fragments. BraidStent®-H avoids the side effects associated with current ureteral stents, thus should cause less discomfort to patients.
双 J 输尿管支架在泌尿科患者中广泛用于引流上尿路。不幸的是，输尿管支架并非没有并发症，因为细菌定植，需要进行第二次取出手术。本研究的目的是评估一种新的肝素涂层可生物降解的抗反流输尿管支架（BraidStent®-H），以防止尿液细菌定植。
总共 24 只雌性猪进行了菌尿检测，并进行了肾超声、内镜和对比荧光透视尿路评估。然后，动物被随机分为两组，I 组放置 5Fr 双猪尾输尿管支架 6 周，或 II 组放置 BraidStent®-H。在 1、3、6、8、12 周进行随访评估。最终随访包括上述方法，并在 20 周后完成对尿路的全面病理研究。
在最初的 48 小时内，两组在 6 小时和 12 小时的细菌定植结果存在显著差异。无症状菌尿在 II 组中直到 48 小时才达到 100%的动物，而在 I 组中则在 6 小时时出现。每周菌尿平均率分别为 I 组 27.7%和 II 组 44.4%，无统计学意义。在 II 组中，没有动物出现膀胱输尿管反流，与 I 组在 3 周和 6 周时有统计学意义。91.2%的 II 组支架在 3 至 6 周内降解，没有阻塞碎片。在 1 至 6 周内，66.6-75%的 II 组远端输尿管蠕动得到维持。
肝素涂层的 BraidStent®可早期减少细菌定植，但长期效果不佳。肝素涂层不影响支架降解率或碎片大小。BraidStent®-H 避免了当前输尿管支架相关的副作用，因此可能会给患者带来更少的不适。
