Drake Marcus J, Clavica Francesco, Murphy Cathy, Fader Mandy J
Department of Surgery and Cancer, Imperial College, London, UK; Department of Urology, Charing Cross Hospital, London, UK.
ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur Urol Focus. 2024 Sep;10(5):713-719. doi: 10.1016/j.euf.2024.09.015. Epub 2024 Sep 28.
Bacteriuria is anticipated in long-term indwelling catheter (IDC) use, and urinary tract infections (UTIs) and related issues are common. Defence mechanisms against infection are undermined by the presence of a Foley catheter, and adjustments to design could influence UTI risk.
We reviewed the various aspects of IDCs and ureteric stent designs to discuss potential impact on UTI risk.
Design adaptations have focussed on reducing the sump of undrained urine, potential urinary tract trauma, and bacterial adherence. Experimental and computational studies on ureteral stents found an interplay between urine flow, bacterial microcolony formation, and accumulation of encrusting particles. The most critical regions for biofilm and crystal accumulation are associated with low shear stress. The full drainage system is the functioning unit, not just the IDC in isolation. This means reliably keeping the drainage system closed and considering whether a valve is preferred to a collection bag. Other developments may include one-way valves, obstacles to "bacterial swimming", and ultrasound techniques. Preventing or clearing IDC blockage can exploit access via the lumen or retaining balloon. Progress in computational fluid dynamics, energy delivery, and soft robotics may increase future options. Clinical data on the effectiveness of IDC design features are lacking, which is partly due to reliance on proxy measures and the challenges of undertaking trials.
Design changes are legitimate lines of development, but are only indirect for UTI prevention. Modifications may be advantageous, but might potentially bring problems in other ways. Education of health care professionals can improve UTIs and should be prioritised.
Catheters used to help bladder drainage can cause urinary infections, and improvements in design might reduce the risk. Several approaches are described in this review. However, proving that these approaches work is a challenge. Training professionals in the key aspects of catheter care is important.
长期使用留置导尿管（IDC）时预计会出现菌尿，尿路感染（UTI）及相关问题很常见。Foley导尿管的存在会削弱抗感染防御机制，设计调整可能会影响UTI风险。
我们回顾了IDC和输尿管支架设计的各个方面，以讨论对UTI风险的潜在影响。
设计改进主要集中在减少未引流尿液的积聚、潜在的尿路创伤以及细菌黏附。对输尿管支架的实验和计算研究发现，尿流、细菌微菌落形成和结垢颗粒积累之间存在相互作用。生物膜和晶体积累的最关键区域与低剪切应力有关。完整的引流系统是功能单元，而不仅仅是孤立的IDC。这意味着要可靠地保持引流系统关闭，并考虑阀门是否比集尿袋更可取。其他进展可能包括单向阀、阻碍“细菌游动”的障碍物和超声技术。预防或清除IDC堵塞可通过管腔或固定球囊进行。计算流体动力学、能量输送和软机器人技术的进展可能会增加未来的选择。缺乏关于IDC设计特征有效性的临床数据，部分原因是依赖替代指标以及开展试验面临的挑战。
设计改变是合理的发展方向，但对预防UTI只是间接的。修改可能有好处，但也可能在其他方面带来问题。对医护人员的教育可以改善UTI情况，应优先进行。
用于帮助膀胱引流的导尿管可能会导致尿路感染，设计改进可能会降低风险。本综述描述了几种方法。然而，证明这些方法有效是一项挑战。对专业人员进行导尿管护理关键方面的培训很重要。
