Innovation and new technology in ureteral stents

Authors

  • Tongtra Watcharawittayakul Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
  • Manint Usawachintachit Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

DOI:

https://doi.org/10.52786/isu.a.39

Keywords:

Ureteral stent, stent-related symptoms, innovation

Abstract

Ureteral stent insertion is a procedure performed extensively by all urologists. Nevertheless, stent-related symptoms and stent encrustation are still common complications pushing the innovation and development of novel ureteral stents. Developments are focussing on three significant aspects: material, design, and removal technique. Various materials including silicone, polymers, and metals are frequently utilized, with or without an additional coating. The use of biodegradable materials is looking promising but these is a lack of proven clinical trials in association with this in humans. The new designs focus on the reduction of stent-related symptoms through the modification of the bladder end. The new stent removal techniques with extraction strings or novel magnetic end may exclude subsequent cystoscopic procedures. Finally, utilization of a ureteral stent tracker application helps in reminding both physicians and patients to remove the stent at the appropriate time.

References

Forbes C, Scotland KB, Lange D, Chew BH. Innovations in Ureteral Stent Technology. Urol Clin North Am 2019;46:245-55.

Donahue RP, Stamm AW, Gibbons RP, Porter CR, Kobashi KC, Corman JM, et al. Evolution of the Ureteral Stent: The Pivotal Role of the Gibbons Ureteral Catheter. Urology 2018;115:3-7.

Williams KG, Blacker AJR, Kumar P. Ureteric stents: The past, present and future. J Clin Urol 2017;11:280-4.

Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol 1967;97:840- 4.

Gibbons RP, Correa RJ, Cummings KB, Mason JT. Experience with Indwelling Ureteral Stent Catheters. J Urol 1976;115:22-6.

Finney RP. Experience with New Double J Ureteral Catheter Stent. J Urol 1978;120:678-81.

Pauer W, Lugmayr H. Metallic Wallstents: A New Therapy for Extrinsic Ureteral Obstruction. J Urol 1992;148:281-4.

Koprowski C, Kim C, Modi PK, Elsamra SE. Ureteral Stent-Associated Pain: A Review. J Endourol 2016;30:744-53.

Joshi HB, Newns N, Stainthorpe A, MacDonagh RP, Keeley FX, Jr, Timoney AG. Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure. J Urol 2003;169:1060-4.

Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX, Jr, Timoney AG, Barry MJ. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 2003;169:1065-9; discussion 9.

Joshi HB, Okeke A, Newns N, Keeley FX, Jr, Timoney AG. Characterization of urinary symptoms in patient with ureteral stents. Urology 2002;59:511-6.

Betschart P, Zumstein V, Piller A, Schmid HP, Abt D. Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review. Int J Urol 2017;24:250-9.

Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical Management of Stones: American Urological Association/ Endourological Society Guideline, PART II. J Urol 2016;196:1161-9.

Navanimitkul N, Lojanapiwat B. Efficacy of tamsulosin 0.4 mg/day in relieving double-J stent-related symptoms: a randomized controlled study. J Int Med Res 2010;38:1436-41.

Chen YB, Gao L, Jiang Q, Ran K, Luo RT. Tamsulosin Monotherapy Is Effective in Reducing Ureteral Stent-related Symptoms: A Meta-analysis of Randomized Controlled Studies. Curr Med Sci 2019;39:707-18.

Wang J, Zhang X, Zhang T, Mu J, Bai B, Lei Y. The role of solifenacin, as monotherapy or combination with tamsulosin in ureteral stent-related symptoms: a systematic review and meta-analysis. World J Urol 2017;35:1669-80.

Zhang YM, Chu P, Wang WJ. PRISMA-combined alpha-blockers and antimuscarinics for ureteral stent-related symptoms: A meta-analysis. Medicine (Baltimore) 2017;96:e6098.

Ragab M, Soliman MG, Tawfik A, Abdel Raheem A, El-Tatawy H, Abo Farha M, et al. The role of pregabalin in relieving ureteral stent-related symptoms: a randomized controlled clinical trial. Int Urol Nephrol 2017;49:961-6.

Tae BS, Cho S, Jeon BJ, Choi H, Park JY, Cho SY, et al. Does mirabegron relieve ureteric stent-related discomfort? A prospective, randomized, multicentre study. BJU Int 2018;122:866-72.

Khoddami S, Chew BH, Lange D. Problems and solutions of stent biofilm and encrustations: A review of literature. Turk J Urol 2020;46:S11-8.

Huabkong M, Bunyaratavej C, Ungchareonwattana W, Phajik S, Sittimak R. Characteristics of ureteral stent encrustation in non-stone forming patients.Thai J Urol 2013;34:1-12.

Kawahara T, Ito H, Terao H, Yoshida M, Matsuzaki J. Ureteral stent encrustation, incrustation, and coloring: morbidity related to indwelling times. J Endourol 2012;26:178-82.

Venkatesan N, Shroff S, Jayachandran K, Doble M. Polymers as ureteral stents. J Endourol 2010;24:191-8.

Krambeck AE, Walsh RS, Denstedt JD, Preminger GM, Li J, Evans JC, et al. A novel drug eluting ureteral stent: a prospective, randomized, multicenter clinical trial to evaluate the safety and effectiveness of a ketorolac loaded ureteral stent. J Urol 2010;183:1037-42.

Cadieux PA, Chew BH, Nott L, Seney S, Elwood CN, Wignall GR, et al. Use of triclosaneluting ureteral stents in patients with long-term stents. J Endourol 2009;23:1187-94.

Zhao J, Cao Z, Lin H, Yang H, Li J, Li X, et al. In vivo research on Cubearing ureteral stent. J Mater Sci Mater Med 2019;30:83.

Cauda F, Cauda V, Fiori C, Onida B, Garrone E. Heparin coating on ureteral Double J stents prevents encrustations: an in vivo case study. J Endourol 2008;22:465-72.

Laube N, Kleinen L, Bradenahl J, Meissner A. Diamond-like carbon coatings on ureteral stents--a new

strategy for decreasing the formation of crystalline bacterial biofilms? J Urol 2007;177:1923-7.

El-Nahas AR, Lachine M, Elsawy E, Mosbah A, El-Kappany H. A randomized controlled trial comparing antimicrobial (silver sulfadiazine)-coated ureteral stents with non-coated stents. Scand J Urol 2018;52:76-80.

Chow PM, Chiang IN, Chen CY, Huang KH, Hsu JS, Wang SM, et al. Malignant Ureteral Obstruction: Functional Duration of Metallic versus Polymeric Ureteral Stents. PLoS One 2015;10:e0135566.

Chung HH, Kim MD, Won JY, Won JH, Cho SB, Seo TS, et al. Multicenter experience of the newly designed covered metallic ureteral stent for malignant ureteral occlusion: comparison with double J stent insertion. Cardiovasc Intervent Radiol 2014;37:463-70.

Chow PM, Hsu JS, Wang SM, Yu HJ, Pu YS, Liu KL. Metallic ureteral stents in malignant ureteral obstruction: short-term results and radiological features predicting stent failure in patients with non-urological malignancies. World J Urol 2014;32:729-36.

Kadlec AO, Ellimoottil CS, Greco KA, Turk TM. Five-year experience with metallic stents for chronic ureteral obstruction. J Urol 2013;190:937-41.

Baumgarten AS, Hakky TS, Carrion RE, Lockhart JL, Spiess PE. A single-institution experience with metallic ureteral stents: a cost-effective method of managing deficiencies in ureteral drainage. Int Braz J Urol 2014;40:225-31.

Kim M, Hong B, Park HK. Long-Term Outcomes of Double-Layered Polytetrafluoroethylene Membrane-Covered Self-Expandable Segmental Metallic Stents (Uventa) in Patients with Chronic Ureteral Obstructions: Is It Really Safe? J Endourol 2016;30:1339-46.

Moskovitz B, Halachmi S, Nativ O. A new self-expanding, large-caliber ureteral stent: results of a multicenter experience. J Endourol 2012;26:1523-7.

Kim JW, Hong B, Shin JH, Park J, Kim JH, Gwon DI, et al. A Prospective Randomized Comparison of a Covered Metallic Ureteral Stent and a Double-J Stent for Malignant Ureteral Obstruction. Korean J Radiol 2018;19:606-12.

Agrawal S, Brown CT, Bellamy EA, Kulkarni R. The thermo-expandable metallic ureteric stent: an 11-year follow-up. BJU Int 2009;103:372-6.

Barros AA, Rita A, Duarte C, Pires RA, Sampaio-Marques B, Ludovico P, et al. Bioresorbable ureteral stents from natural origin polymers. J Biomed Mater Res B Appl Biomater 2015;103:608- 17.

Zhang MQ, Zou T, Huang YC, Shang YF, Yang GG, Wang WZ, et al. Braided thin-walled biodegradable ureteral stent: preliminary evaluation in a canine model. Int J Urol 2014;21:401-7.

Chew BH, Lange D, Paterson RF, Hendlin K, Monga M, Clinkscales KW, et al. Next generation biodegradable ureteral stent in a yucatan pig model. J Urol 2010;183:765-71.

Chew BH, Paterson RF, Clinkscales KW, Levine BS, Shalaby SW, Lange D. In vivo evaluation of the third generation biodegradable stent: a novel approach to avoiding the forgotten stent syndrome. J Urol 2013;189:719-25.

Mitchell HM. URIPRENE: Clinical Study to Evaluate the Safety and Device Performance of the ADVA-Tec Uriprene® Degradable Temporary Ureteral Stent Following Uncomplicated Ureteroscopy 2020 [updated 28 September 2020; cited 2021 30 April]. Available from: https://clinicaltrials.gov/ct2/show/record/NCT04565795.

Barros AA, Browne S, Oliveira C, Lima E, Duarte AR, Healy KE, et al. Drug-eluting biodegradable ureteral stent: New approach for urothelial tu- mors of upper urinary tract cancer. Int J Pharm 2016;513:227-37.

Yeazel TR, Becker ML. Advancing Toward 3D Printing of Bioresorbable Shape Memory Polymer Stents. Biomacromolecules 2020;21:3957-65.

del Junco M, Okhunov Z, Yoon R, Khanipour R, Juncal S, Abedi G, et al. Development and initial porcine and cadaver experience with three-dimensional printing of endoscopic and laparoscopic equipment. J Endourol 2015;29:58-62.

Taguchi M, Yoshida K, Sugi M, Kinoshita H, Matsuda T. Effect of ureteral stent diameter on ureteral stent-related symptoms. Low Urin Tract Symptoms 2019;11:195-9.

Lee JN, Kim BS. Comparison of efficacy and bladder irritation symptoms among three different ureteral stents: a double-blind, prospective, randomized controlled trial. Scand J Urol 2015;49:237-41.

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

Yoshida T, Inoue T, Taguchi M, Matsuzaki T, Murota T, Kinoshita H, et al. Efficacy and Safety of Complete Intraureteral Stent Placement versus Conventional Stent Placement in Relieving Ureteral Stent Related Symptoms: A Randomized, Prospective, Single Blind, Multicenter Clinical Trial. J Urol 2019;202:164-70.

Vogt B. A New Customized Ureteral Stent with Nonrefluxing Silicone End-piece to Alleviate Stent-related Symptoms in Malignant Diseases. Urology 2020;137:45-9.

Vogt B, Desgrippes A, Desfemmes FN. Changing the double-pigtail stent by a new suture stent to improve patient’s quality of life: a prospective study. World J Urol 2015;33:1061-8.

Vogt B, Desfemmes FN, Desgrippes A, Ponsot Y. MiniJFil(R): A New Safe and Effective Stent for Well-Tolerated Repeated Extracorporeal Shockwave Lithotripsy or Ureteroscopy for Medium-to-Large Kidney Stones? Nephrourol Mon 2016;8:e40788.

Inoue T, Okada S, Hamamoto S, Yoshida T, Murota T, Matsuda T. Impact of ureteric stent removal by string on patient’s quality of life and on complications at post-ureteroscopy for urolithiasis: a controlled trial. BJU Int 2019;124:314-20.

Sun X, Dong L, Chen T, Huang Z, Zhang X, Wu J, et al. Pooled analysis of efficacy and safety of ureteral stent removal using an extraction string. Medicine (Baltimore) 2019;98:e17169.

Althaus AB, Li K, Pattison E, Eisner B, Pais V, Steinberg P. Rate of dislodgment of ureteral stents when using an extraction string after endoscopic urological surgery. J Urol 2015;193:2011-4.

Rassweiler MC, Michel MS, Ritter M, Honeck P. Magnetic Ureteral Stent Removal Without Cystoscopy: A Randomized Controlled Trial. J Endourol 2017;31:762-6.

Sancaktutar AA, Soylemez H, Bozkurt Y, Penbegul N, Atar M. Treatment of forgotten ureteral stents: how much does it really cost? A cost-effectiveness study in 27 patients. Urol Res 2012;40:317-25.

Ulker V, Atalay HA, Cakmak O, Yucel C, Celik O, Kozacioglu Z. Smartphone-based stent tracking application for prevention of forgotten ureteral double-J stents: a prospective study. Int Braz J Urol 2019;45:376-83.

Downloads

Published

2021-11-30

How to Cite

Watcharawittayakul, T., & Usawachintachit, M. (2021). Innovation and new technology in ureteral stents. Insight Urology, 42(2), 160–168. https://doi.org/10.52786/isu.a.39

Issue

Section

Review article