Therapeutic Advances in Urology Review

Ther Adv Urol

Ureteral stents: new ideas, new designs (2010) 2(2) 85—92
DOI: 10.1177/
1756287210370699
Abdulrahman Al-Aown, Iason Kyriazis, Panagiotis Kallidonis, Pantelis Kraniotis,
! The Author(s), 2010.
Christos Rigopoulos, Dimitrios Karnabatidis, Theodore Petsas and Evangelos Liatsikos Reprints and permissions:
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Abstract: Ureteral stents represent a minimally invasive alternative to preserve urinary
drainage whenever ureteral patency is deteriorated or is under a significant risk to be occluded
due to extrinsic or intrinsic etiologies. The ideal stent that would combine perfect long-term
efficacy with no stent-related morbidity is still lacking and stent usage is associated with
several adverse effects that limit its value as a tool for long-term urinary drainage. Several new
ideas on stent design, composition material and stent coating currently under evaluation,
foreseen to eliminate the aforementioned drawbacks of ureteral stent usage. In this article we
review the currently applied novel ideas and new designs of ureteral stents. Moreover, we
evaluate potential future prospects of ureteral stent development adopted mostly by the pio-
neering cardiovascular stent industry, focusing, however, on the differences between ureteral
and endothelial tissue.

Keywords: double pigtail, drug-eluting stent, metal stents, resonance, stents, ureteral stents

Introduction the patient. Biocompatibility, radiopacity, visibil- Correspondence to:

Since 1978, when the double-J stent and the
single-pigtail stent were introduced by Finney
and Hepperlen and colleagues to the urological
society, ureteral stent usage has become a routine
practice for every urologist [Finney, 1978,
Hepperlen et al. 1978]. Over the course of time,
many improvements on ureteral stent design and
composition material have taken place in an
attempt to improve the efficacy of the stents.
Nevertheless, ureteral stent usage is associated
with several adverse effects that limit its value as
a tool for long-term urinary drainage. Stent infec-
tion, encrustation or migration, hyperplastic
urothelial reaction and patient’s discomfort are
the most common stent-related problems [Dyer
et al. 2002]. Consequently, the ideal stent that
would combine perfect long-term efficacy with
no stent-related morbidity is still under investiga-
tion. In this article we review the recent advances
in the evolution of the ureteral stent as well as
potential future prospects adopted in the rapidly
evolving cardiovascular stent development.
Ideal ureteral metal stent
The ideal ureteral stent has not yet been
designed. Nevertheless, several authors have out-
lined its characteristics very well. The perfect
ureteral stent should demonstrate optimal flow
characteristics and should be well tolerated by
Evangelos N. Liatsikos,
ity on ultrasound, ease of insertion and removal MD, PhD
are also important features. Moreover, resistance Assistant Professor,
Department of Urology,
to infection, corrosion and encrustation are char- University of Patras
acteristics that are crucial for long-term ureteral Medical School, Rion,
26 500, Patras, Greece
patency. A stent providing long-term ureteral liatsikos@yahoo.com
patency and combining the above features repre- Abdulrahman Al-Aown,
sents the ultimate goal of urological stent MD
Iason Kyriazis, MD
research [Liatsikos et al. 2009; Dyer et al. 2002]. Panagiotis Kallidonis, MD
Christos Rigopoulos, MD
Department of Urology,
Future trends in ureteral stents University of Patras,
The continuous research for the creation of the Greece
ideal stent includes developments in several fea- Dimitrios Karnabatidis,
MD, PhD
tures such as stent design, composition material Theodore Petsas, MD,
and stent coating. Despite the incorporation of PhD
Pantelis Kraniotis, MD
several novel developments of these features on Department of Radiology,
the same stent, we describe the evolution of each University of Patras,
Greece
feature separately for reasons of discrimination.
Stent design
Ureteral metal mesh stents represent a promising
application of vascular mesh stents to urology
aiming to provide ureteral drainage in challenging
cases where the conventional double-pigtail stents
have failed (Figure 1). Mesh stents are composed
of a very delicate metal mesh structure that supports
the integrity of the tubular structure of the stented
ureter, while allowing lateral flexibility to permit safe
stent placement and some kind of postplacement
ureteral movement. Moreover, having numerous

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Therapeutic Advances in Urology 2 (2)
Figure 1. Stented ureter with multiple metal mesh
stents. The patient was suffering from extensive
retroperitoneal metastasis of malignant disease.
holes on their body, mesh stents protect the stented
epithelium from strangulation and ischemia and
minimize irritative symptoms [Olweny et al. 2000].
Further advances in mesh stent design and con-
struction can give additional favorable characteris-
tics to these stents. Taking examples from the use of
mesh stents in the cardiovascular system, the
intra-struts wells on the Conor Medsystems stent
act as drug reservoirs for the creation of drug-eluting
stents (DESs) [Kukreja et al. 2008], while
the XTENT custom NX allows in-vivo
customization of the stent length [Wilkes Evans
et al. 2007].
Tail stents (Microvasive Urology/Boston Scientific)
and dual durometer stents (Sof-Curl/ACMI and
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the Polaris/Microvasive Urology—Boston Scientific)
are stents incorporating other novel design
characteristics. In order to decrease ureteral
stent-related bladder irritability, the tail stent
incorporates a tapered straight distal tail that
resides in the bladder. Dual durometer stents
incorporate a transition from a firm biomaterial
at the renal end to a soft biomaterial or a fine
loop at the bladder end, in an attempt to facili-
tate stent placement, reduce migration and
minimize patient discomfort due to bladder
irritation. Promising results have been reported
for both novel designs [Lingeman et al. 2009;
Lam and Gupta, 2004; Liatsikos et al. 2002;
Dunn et al. 2000].
Vesicoureteral reflux due to ureteral stent place-
ment is considered to be one of the implicated
factors contributing to stent-related patient dis-
comfort. In an attempt to diminish the aforemen-
tioned morbidity an antireflux membrane has
been incorporated into ureteral stents. In a
study enrolling 133 double-J ureteral stents with
and without antireflux membrane, antireflux
stents demonstrated a lower complication rate
and provided higher patient comfort compared
with stents without this valve [Ecke et al. 2010].
Dual lumen ureteral stents have been introduced
to replace the simultaneous insertion of two ipsi-
lateral stents in cases where a single stent’s ure-
teral flow is not satisfactory [Hafron et al. 2006].
Clinical evaluation of this novel idea is awaited.
In addition, good results have been published
with horn-shaped stents used for the stenting of
ureteropelvic junction [Talja et al. 2002]. Finally,
an old idea from 1989 is being revisited for the
possible incorporation in future stent designs: the
presence of magnetic materials in ureteral stents.
By this approach, stent removal can be per-
formed via minimally invasive techniques using
a magnet on a special retrieval catheter.
Magnetip (ACMI [Surgitek], Racine, WI) is a
magnetic-material-tipped ureteral stent that can
be retrieved without the need for cystoscopy
using the aforementioned concept [Taylor and
McDougall, 2002; Macaluso et al. 1989].
At this point, we have to emphasize that future
trends in ureteral stent design do not necessarily
involve totally novel ideas. Several currently avail-
able stent designs, including the common
double-J polymeric stent, the full metal double-J
stent (Resonance stent, Cook Ireland, Limerick,
Ireland; see Figure 2) or the thermoexpandable
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Figure 2. The lower pigtail end of a full metal double-pigtail resonance stent. Note the unique spiral metal
structure of the stent which provides adequate resistance to external tension.
shape memory stents (Memokath 051, Engineers
& Doctors A/S, Copenhagen, Denmark) have
already demonstrated quite promising results
[Liatsikos et al. 2010; Agrawal et al. 2009;
Kulkarni and Bellamy, 2001]. Their current effi-
cacy is good but not ideal. Combining of their
tested effective design with future developments
in composition materials and/or stent coatings, as
described in the following, can create totally new
stents with enhanced long-term efficiency.
Composition materials
The gold standard of composition material in the
case of ureteral stents is polymeric compounds,
including silicone, polyurethane Siliteck, C-Flex,
Percuflex, Tecoflex and others [Venkatesan et al.
2010; Beiko et al. 2003]. The reason for the use
of polymeric materials is that, in general, they
appear to be more inert in nature than metals
or other substances. However, polymeric stents
demonstrate certain limits in their ability to
resist external compression forces [Christman
et al. 2009]. Thus, metallic materials have been
introduced to create more resistant stents indi-
cated for diseases such as malignant extrinsic ure-
teral obstruction where compression forces are
expected to be high [Pedro et al. 2007]. Nitinol
(nickel/titanium alloy), superalloy titanium,
stainless steel and chromium cobalt are the
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A Al-Aown, I Kyriazis et al.
most commonly used materials in metal ureteral
stents. There are ongoing attempts to create a
combination of a polymeric stent coating devel-
oped with a metal skeleton, with the objective of
constructing a stent combining both polymeric
inertness and metal strength characteristics
[Pedro et al. 2007; Trueba Arguinarena and
Fernandez del Busto, 2004; Ko et al. 2002;
Leveillee et al. 1998].
In an attempt to avoid the repeated cystoscopy
during stent removal, several biodegrad-
able—bioabsorbable materials have been intro-
duced in stent composition. Polyglycolide, Poly
D, L lactide, Poly L lactide and Uriprene are bio-
degradable polymeric materials that when used
for ureteral stent composition can induce total
stent absorption over a varied period [Chew
et al. 2010; Talja et al. 2002]. Degradation time
depends both on the material used and the
amount of substance to be degraded. For exam-
ple, second-generation stents are degraded from
the distal to the proximal end because the coating
is thicker on the more proximal portion [Chew
et al. 2010]. Current data on biodegradable stent
application in the human ureter are limited.
Moreover, several problems with this novel idea
have already been encountered. Phase II trials of
a temporary ureteral drainage stent (Boston
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Therapeutic Advances in Urology 2 (2)
Scientific Microvasive, Natick, MA) revealed that
in some cases stent fragments did not dissolve
properly and required shock-wave lithotripsy
and ureteroscopy for removal [Lingeman et al.
2003]. Another stent composed of
poly-L-lactide-co-glycolide (PLGA), evaluated
for its use after retrograde endopyelotomy in a
porcine model, was not pursued clinically due
to incompatibility issues [Olweny et al. 2002].
In addition, conditions such as ureteral strictures
need a prolonged time of stenting in contrast to
other procedures such as after shock-wave litho-
tripsy when a short-term ureteral drainage is indi-
cated. Consequently, a single biodegradable stent
cannot fit all conditions and disease-specific stent
development is required. New bioabsorbable
stents are already under experimental evaluation
demonstrating promising results and clinical
trials are expected. Second-generation biode-
gradable stents such as the UripreneÕ stent com-
posed of suture-like material begins degrading at
2 weeks and are completely degraded by 10
weeks after placement. Third-generation biode-
gradable stents are fully degraded by 4 weeks.
Experimental data in pigs confirms the biocom-
patibility and efficiency of these evolved stents.
Nevertheless, clinical data in humans are still
lucking [Chew et al. 2010].
Stent coatings
The stent industry quite quickly realized that
instead of searching for the ideal composition
material for the creation of novel stents, current
materials and stent designs could be used as the
platforms to be covered with other substances
with desirable characteristics. Stent coating is
the part of stent evolution with the most sig-
nificant development and the most promising
future prospects.
Several substances have been tested as potential
coatings for urinary tract stents. Polymeric stents
can be coated with a variety of nondissolvable
polymers (AQ, Cook Urological; Lse, Cook
Urological; SL-6, Applied Medical, CA, USA;
HydroPlus, Boston Scientific, MA, USA) which
increase biocompatibility and reduce friction
between the stent and ureter during placement
[Liatsikos et al. 2010]. Enhanced biocompatibil-
ity and friction characteristics of ureteral stents
are related to a decrease in postplacement
urothelial reaction, biofilm formation and, conse-
quently, long-term stent efficiency.
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Heparin is very promising ureteral stent coating.
Heparin-coated polymeric stents (Endo-Sof
Radiance, Cook Urological) provide to the stent
an antiadhesive surface that reduces biofilm for-
mation and concomitant stent encrustation.
Consequently, this coating can postpone stent
replacement providing a useful tool for long-
term urinary drainage. When indwelled for 10
and 12 months in two human cases, heparin-
coated stents were found to be free of encrusta-
tion [Cauda et al. 2008]. Nevertheless, the ability
of the heparin coating to demonstrate an inhibi-
tory effect on bacterial adherence was not verified
in vitro [Lange et al. 2009]. Coating stents with
active enzymes that would degrade surface bio-
material deposits is an alternative idea to reduce
stent encrustation. In an in-vivo rabbit bladder
implantation model, enzyme-coated (oxalyl-
coenzyme A and formyl coenzyme) silicone
disks were found to demonstrate a reduction in
the amount of encrustation after 30 days of
implantation versus control disks [Watterson
et al. 2003].
Diamond-like carbon coating is a plasma-depos-
ited diamond-like amorphous carbon material
that is characterized by its excellent biocompati-
bility. A preliminary study in 10 patients using a
stent with this coating demonstrated quite prom-
ising results. A decrease in stent friction, encrus-
tation tendencies and biofilm formation was
reported [Laube et al. 2007]. Further investiga-
tion in larger patient groups is necessary to con-
firm the superiority of this novel coating.
Hydrogel is a coating surface modification
method applied mostly in ureteral stents that
allows the anchoring of water molecules on the
stent’s surface. Hydrogel-coated stents share
advantages such as improved material bio-
compatibility, hydrophilization and lubrication
[Chew and Denstedt, 2004]. A combination of
the hydrophilic matrix with hydrophobic drugs
seems to be especially promising. In an experi-
mental study, John and colleagues dipped
hydrogel-coated ureteral stents into solutions of
ciprofloxacin, gentamicin and cefazolin, and
proved that the created stents demonstrated
antimicrobial properties [John et al. 2007].
Polytetrafluoroethylene (PTFE) is another stent
coating used in metal stents that increases the
stent’s biocompatibility. As a result, the epithelial
reaction to the metal stent is limited.
Experimental data in canine ureters have demon-
strated that PTFE-covered metallic stents
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effectively prevent the luminal occlusion caused
by urothelial hyperplasia [Chung et al. 2008].
An alternative novel tool for the confrontation of
urothelial hyperplasia following ureteral stent
placement is expected to be provided from the
use of DESs. DESs, one of the largest coronary
stent categories, have recently been evaluated for
use in the urinary tract. Certain DESs can sup-
press neointimal hyperplasia following vascular
stent placement. Experimental data verify that
the urothelium responds in the same way. A sig-
nificant redaction in urethral and ureteral urothe-
lial hyperplasia was demonstrated after pactitaxel
DES placement in the pig ureter and canine ure-
thra [Liatsikos et al. 2007; Shin et al. 2005].
Clinical trials are necessary in order to verify
the promising experimental results and define
the efficacy of the new ureteral stents in the
human ureter.
Following the same idea of incorporating drugs
onto the stent surface, several other substances
have already been used in DESs in an attempt
to diminish stent-related adverse effects.
Promising results have been demonstrated in
the case of ureteral stents loaded with Triclosan
and Ketorolac. Triclosan is a broad-spectrum
antimicrobial agent incorporated on ureteral
stents to prevent stent infection. When
Triclosan-eluting stents were indwelled for 3
months in eight patients a decreased antibiotic
usage and significantly fewer symptomatic infec-
tions were noted. Nevertheless, a clinical benefit
in terms of urine and stent cultures or overall
subject symptoms was not revealed [Cadieux
et al. 2009]. Ketorolac is a nonsteroidal anti-
inflammatory drug incorporated onto ureteral
stents to minimize stent-related discomfort. In a
prospective, multicenter, double-blind study
enrolling 276 patients the overall safety of the
Ketorolac-loaded stent was confirmed. A trend
toward a treatment benefit was noted since
patients appeared to require less pain medication
[Krambeck et al. 2010]. Future studies with
higher drug concentrations or alternative antibi-
otic agents or painkillers are expected to retrieve
superior clinical benefit in both cases of DESs.
The future direction of cardiovascular
stent development
The cardiovascular stent industry is a very prof-
itable area. Thus, increased competition between
stent manufacturers is present, speeding up the
rate of development. During the last few years the
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A Al-Aown, I Kyriazis et al.
particular field of medical device production has
seen many advances, including antibody-coated
stents, biomimetic, biocovered and bioactive
stents. Obviously, urological stent development
has much to gain from these advances.
Antibody-coated stents
Recently, techniques allowing the creation of
antibody-coated stents have been introduced.
The created stents should allow adhesion and
proliferation of the surrounding mature endothe-
lial cells and circulating endothelial progenitor
cells, which is of primary importance for the
in-situ rapid re-endothelialization of cardiovascu-
lar stents [Yin et al. 2009]. The particular adhe-
sion ability appears to be of low importance for
future application in ureteral stents given that
normally no endothelial cells are present in the
urinary tract. However, the prospect of antibody-
coated stents might allow in the near future the
targeted attraction and anchoring of particular
elements flowing in the urine that might interfere
positively with stent epithelization, urothelial
hyperplastic reaction, biofilm formation and
stent encrustation.
Biomimetic coatings and biocovered stents
Another very promising advance in stent technol-
ogy is the creation of a phospholipid copolymer
that mimics biological membranes. The creation
of biomimetic stents is expected to increase the
biocompatibility of future stents [Fan et al.
2007]. Nakayama and colleagues and Fu and
coworkers recently developed methods for the
creation of in-vivo tissue-engineered autologous
tissue-covered stents. This novel insight opens
the era of ‘biocovered’ stents that would be rec-
ognized as self by the hosting organism. Further,
data on the subject are expected [Fu et al. 2009;
Nakayama et al. 2007]. Based on the same idea
that the use of a natural stent made of autologous
tissue would be advantageous due to its biocom-
patibility, ongoing attempts for the development
of tissue-engineered stents from chondrocytes are
present. The feasibility of creating cartilaginous
stents in vitro and in vivo using chondrocytes-
seeded polymer matrices has already been dem-
onstrated [Amiel et al. 2001].
Finally, Fine and colleagues demonstrated that
rosette nanotube-coated titanium vascular stents
can evoke an enhanced endothelial cell adhesion
on the metal stent. The rosette nanotubes is a
biomimetic nanostructured coating that mimics
the dimensions of natural components of tissues,
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Therapeutic Advances in Urology 2 (2)
such as collagen fibrils. Consequently, endothe-
lial cells passing through the stented vessel can
easily attach to the particular coating creating a
uniform healthy endothelium masking the under-
lying foreign metal [Fine et al. 2009].
Titanium nitride-oxide coating
A titanium nitride-oxide coating has also been
developed. Titanium appears to render the
stent surface biologically inert. Consequently, in
a potential appliance of this technology in ure-
teral stents, biofilm formation and stent-induced
urothelial hyperplasia are expected to be
decreased [Windecker et al. 2001].
Bioactive stents
Sargeant and colleagues recently described a
technique of altering the surface chemistry of
nickel—titanium (NiTi) shape memory alloy in
order to covalently attach self-assembled nanofi-
bers with bioactive functions. These can promote
specific biological responses from host tissues
such as immobilization of certain proteins and
peptides for directed cellular responses, immobi-
lization of gene vectors and immobilization of
antibodies for cellular adhesion [Sargeant et al.
2008]. In other words future NiTi ureteral
stents can be modified by this technique and
create a bioactive surface interfering positively
with the underlying urothelium.
Radioactive stents
Radioactive stents have been tested in cardiovas-
cular research and have been almost abandoned
due to high rate of restenosis outside the stent
edges (a phenomenon called the ‘edge effect’)
[Arab et al. 2001]. Nevertheless, ureteral tissue
shares few common characteristics with coronary
vessels, so future testing might reveal a promising
new field for radioactive stents. Stent occlusion
due to urothelial and granulation tissue hyperpla-
sia might be prevented with an inhibitor of cell
growth, such as ionizing radiation. Selective ion
implantation of b-particle-emitting radioisotopes
such as phosphorus-32 into the surface of stents
is proven to be technically possible and cost effec-
tive. Stents wearing gamma-emitting isotopes
have also been developed. A future evaluation
of this already established technology in urology
appears promising.
Novel stents
In matters of novel composition materials,
fully biodegradable/bioabsorbable metal mesh
stents have recently been introduced. AMS
(Biotronik) is an absorbable magnesium metal
90
stent that combines radiopaque, high accuracy
in positioning and a high revascularization rate
[Erbel et al. 2007].
Conclusion
Ureteral stent development is currently focusing
on the enhancement and evolution of stent
design, composition material and stent coating.
Several novel ideas currently under evaluation
have demonstrated quite promising results, rais-
ing hopes that ureteral stents will improve their
current efficiency and become a tool for the man-
agement of a growing variety of new indications
in the near future. Cardiovascular stent research
is leading the way, introducing new ideas with
possible promising implication in urinary tract
stenting. Nevertheless, the ureter has different
structural and histological characteristics as well
as pathophysiological mechanisms implicated in
the failure of long-term stenting. Consequently,
cardiovascular stent developments would proba-
bly require further refinement for ureteral appli-
cation. Research and development of ureteral
stents requires an extensive understanding of
the mechanisms involved in ureteral stent failure.
Urothelial hyperplasia, stent biofilm formation
and encrustation, ureteral mobility and response
to ureteral intraluminal foreign-body stimuli are
only few of the implicated mechanisms that are
not fully understood. Thus, further investigation
is deemed necessary.
Conflict of interest statement
This research received no specific grant from any
funding agency in the public, commercial, or not-
for-profit sectors.
References
Agrawal, S., Brown, C.T., Bellamy, E.A. and Kulkarni,
R. (2009) The thermo-expandable metallic ureteric
stent: an 11-year follow-up. Br J Urol Int 103: 372—376.
Amiel, G.E., Yoo, J.J., Kim, B.S. and Atala, A. (2001)
Tissue engineered stents created from chondrocytes.
J Urol 165: 2091—2095.
Arab, A., Bode, C. and Hehrlein, C. (2001) The
radioactive stent—any chance of a resurrection? Eur
Heart J 22: 1245—1247.
Beiko, D.T., Knudsen, B.E. and Denstedt, J.D. (2003)
Advances in ureteral stent design. J Endourol
17: 195—199.
Cadieux, P.A., Chew, B.H., Nott, L., Seney, S.,
Elwood, C.N., Wignall, G.R. et al. (2009) Use of
triclosan-eluting ureteral stents in patients with long-
term stents. J Endourol 23: 1187—1194.
http://tau.sagepub.com

Cauda, F., Cauda, V., Fiori, C., Onida, B. and
Garrone, E. (2008) Heparin coating on ureteral
double J stents prevents encrustations: an in vivo case
study. J Endourol 22: 465—472.
Chew, B.H. and Denstedt, J.D. (2004) Technology
insight: novel ureteral stent materials and designs.
Nat Clin Pract Urol 1: 44—48.
Chew, B.H., Lange, D., Paterson, R.F., Hendlin, K.,
Monga, M., Clinkscales, K.W. et al. (2010) Next
generation biodegradable ureteral stent in a Yucatan
pig model. J Urol 183: 765—771.
Christman, M.S., L’esperance, J.O., Choe, C.H.,
Stroup, S.P. and Auge, B.K. (2009) Analysis of ure-
teral stent compression force and its role in malignant
obstruction. J Urol 181: 392—396.
Chung, H.H., Lee, S.H., Cho, S.B., Park, H.S.,
Kim, Y.S., Kang, B. et al. (2008) Comparison of a new
polytetrafluoroethylene-covered metallic stent to a
noncovered stent in canine ureters. Cardiovasc
Intervent Radiol 31: 619—628.
Dunn, M.D., Portis, A.J., Kahn, S.A., Yan, Y.,
Shalhav, A.L., Elbahnasy, A.M. et al. (2000) Clinical
effectiveness of new stent design: Randomized single-
blind comparison of tail and double-pigtail stents.
J Endourol 14: 195—202.
Dyer, R.B., Chen, M.Y., Zagoria, R.J., Regan, J.D.,
Hood, C.G. and Kavanagh, P.V. (2002) Complications
of ureteral stent placement. Radiographics
22: 1005—1022.
Ecke, T.H., Bartel, P., Hallmann, S. and Ruttloff, J.
(2010) Evaluation of symptoms and patients’ comfort
for JJ-ureteral stents with and without antireflux-
membrane valve. Urology 75: 212—216.
Erbel, R., Di Mario, C., Bartunek, J., Bonnier, J.,
de Bruyne, B., Eberli, F.R. et al. (2007) Temporary
scaffolding of coronary arteries with bioabsorbable
magnesium stents: a prospective, non-randomised
multicentre trial. Lancet 369: 1869—1875.
Fan, D., Jia, Z., Yan, X., Liu, X., Dong, W., Sun, F.
et al. (2007) Pilot study of a cell membrane like bio-
mimetic drug-eluting coronary stent. Sheng Wu Yi Xue
Gong Cheng Xue Za Zhi 24: 599—602.
Fine, E., Zhang, L., Fenniri, H. and Webster, T.J.
(2009) Enhanced endothelial cell functions on rosette
nanotube-coated titanium vascular stents. Int J
Nanomedicine 4: 91—97.
Finney, R.P. (1978) Experience with new double J
ureteral catheter stent. J Urol 167: 1135—1138;
discussion 1139.
Fu, W.J., Zhang, X., Zhang, B.H., Zhang, P., Hong,
B.F., Gao, J.P. et al. (2009) Biodegradable urethral
stents seeded with autologous urethral epithelial cells
in the treatment of post-traumatic urethral stricture:
a feasibility study in a rabbit model. BJU Int
104: 263—268.
Hafron, J., Ost, M.C., Tan, B.J., Fogarty, J.D.,
Hoenig, D.M., Lee, B.R. et al. (2006) Novel
http://tau.sagepub.com
A Al-Aown, I Kyriazis et al.
dual-lumen ureteral stents provide better ureteral flow
than single ureteral stent in ex vivo porcine kidney
model of extrinsic ureteral obstruction. Urology
68: 911—915.
Hepperlen, T.W., Mardis, H.K. and Kammandel, H.
(1978) Self-retained internal ureteral stents: a new
approach. J Urol 119: 731—734.
John, T., Rajpurkar, A., Smith, G., Fairfax, M. and
Triest, J. (2007) Antibiotic pretreatment of hydrogel
ureteral stent. J Endourol 21: 1211—1216.
Ko, G.Y., Kim, G.C., Seo, T.S., Kim, T.H., Lim, J.O.,
Lee, J.H. et al. (2002) Covered, retrievable, expand-
able urethral nitinol stent: feasibility study in dogs.
Radiology 223: 83—90.
Krambeck, A.E., Walsh, R.S., Denstedt, J.D.,
Preminger, G.M., Li, J., Evans, J.C. et al. (2010) A
novel drug eluting ureteral stent: a prospective, ran-
domized, multicenter clinical trial to evaluate the
safety and effectiveness of a ketorolac loaded ureteral
stent. J Urol 183: 1037—1042.
Kukreja, N., Onuma, Y., Daemen, J. and Serruys, P.W.
(2008) The future of drug-eluting stents. Pharmacol
Res 57: 171—180.
Kulkarni, R.P. and Bellamy, E.A. (2001) Nickel-tita-
nium shape-memory alloy memokath 051 ureteral
stent for managing long term ureteral obstruction:
4-year experience. J Urol 166: 1750—1754.
Lam, J.S. and Gupta, M. (2004) Update on ureteral
stents. Urology 64: 9—15.
Lange, D., Elwood, C.N., Choi, K., Hendlin, K.,
Monga, M. and Chew, B.H. (2009) Uropathogen
interaction with the surface of urological stents
using different surface properties. J Urol
182: 1194—1200.
Laube, N., Kleinen, L., Bradenahl, J. and Meissner, A.
(2007) Diamond-like carbon coatings on ureteral
stents—a new strategy for decreasing the formation
of crystalline bacterial biofilms? J Urol
177: 1923—1927.
Leveillee, R.J., Pinchuk, L., Wilson, G.J. and Block,
N.L. (1998) A new self-expanding lined stent-graft in
the dog ureter: radiological, gross, histopathological
and scanning electron microscopic findings. J Urol
160: 1877—1882.
Liatsikos, E.N., Hom, D., Dinlenc, C.Z., Kapoor, R.,
Alexianu, M., Yohannes, P. et al. (2002) Tail stent
versus reentry tube: A randomized comparison
after percutaneous stone extraction. Urology
59: 15—19.
Liatsikos, E., Kallidonis, P., Kyriazis, I.,
Constantinidis, C., Hendlin, K., Stolzenburg, J.U.
et al. (2010) Ureteral obstruction: is the full metallic
double-pigtail stent the way to go? Eur Urol
57: 480—487.
Liatsikos, E., Kallidonis, P., Stolzenburg, J.U. and
Karnabatidis, D. (2009) Ureteral stents: past, present
and future. Expert Rev Med Devices 6: 313—324.
91
Therapeutic Advances in Urology 2 (2)
Liatsikos, E.N., Karnabatidis, D., Kagadis, G.C.,
Rokkas, K., Constantinides, C., Christeas, N. et al.
(2007) Application of paclitaxel-eluting metal mesh
stents within the pig ureter: an experimental study. Eur
Urol 51: 217—223.
Lingeman, J.E., Preminger, G.M., Berger, Y.,
Denstedt, J.D., Goldstone, L., Segura, J.W. et al.
(2003) Use of a temporary ureteral drainage stent after
uncomplicated ureteroscopy: results from a phase II
clinical trial. J Urol 169: 1682—1688.
Lingeman, J.E., Preminger, G.M., Goldfischer, E.R.
and Krambeck, A.E.; Comfort Study Team. (2009)
Assessing the impact of ureteral stent design on patient
comfort. J Urol 181: 2581—2587.
Macaluso Jr, J.N., Deutsch, J.S., Goodman, J.R.,
Appell, R.A., Prats Jr, L.J. and Wahl, P. (1989) The
use of the Magnetip double-J ureteral stent in uro-
logical practice. J Urol 142: 701—703.
Nakayama, Y., Zhou, Y.M. and Ishibashi-Ueda, H.
(2007) Development of in vivo tissue- engineered
autologous tissue-covered stents. J Artif Organs
10: 171—176.
Olweny, E.O., Landman, J., Andreoni, C., Collyer, W.,
Kerbl, K., Onciu, M. et al. (2002) Evaluation of the
use of a biodegradable ureteral stent after retrograde
endopyelotomy in a porcine model. J Urol
167: 2198—2202.
Olweny, E.O., Portis, A.J., Sundaram, C.P., Afane,
J.S., Humphrey, P.A., Ewers, R. et al. (2000)
Evaluation of a chronic indwelling prototype mesh
ureteral stent in a porcine model. Urology
56: 857—862.
Pedro, R.N., Hendlin, K., Kriedberg, C. and Monga,
M. (2007) Wire-based ureteral stents: impact on tensile
strength and compression. Urology 70: 1057—1059.
Visit SAGE journals online
http://tau.sagepub.com
Sargeant, T.D., Rao, M.S., Koh, C.Y. and Stupp, S.I.
(2008) Covalent functionalization of NiTi surfaces
92
with bioactive peptide amphiphile nanofibers.
Biomaterials 29: 1085—1098.
Shin, J.H., Song, H.Y., Choi, C.G., Yuk, S.H., Kim,
J.S., Kim, Y.M. et al. (2005) Tissue hyperplasia:
influence of a paclitaxel-eluting covered stent-preli-
minary study in a canine urethral model. Radiology
234: 438—444.
Talja, M., Multanen, M., Välimaa, T. and Törmälä, P.
(2002) Bioabsorbable SR-PLGA horn stent after
antegrade endopyelotomy: a case report. J Endourol
16: 299—230.
Taylor, W.N. and McDougall, I.T. (2002) Minimally
invasive ureteral stent retrieval. J Urol 168: 2020—2023.
Trueba Arguinarena, F.J. and Fernandez del Busto, E.
(2004) Self-expanding polytetrafluoroethylene covered
ninitol stents for the treatment of ureteral stenosis:
preliminary report. J Urol 172: 620—623.
Venkatesan, N., Shroff, S., Jayachandran, K. and
Doble, M. (2010) Polymers as ureteral stents.
J Endourol 24: 191—198.
Watterson, J.D., Cadieux, P.A., Beiko, D.T., Cook,
A.J., Burton, J.P., Harbottle, R.R. et al. (2003)
Oxalate-degrading enzymes from Oxalobacter formigenes:
a novel device coating to reduce urinary tract biomater-
ial-related encrustation. J Endourol 17: 269—274.
Wilkes Evans, L., Doran, P. and Marco, P. (2007)
XTENTÕ Custom NX drug eluting stent systems.
EuroIntervention 3: 158—161.
Windecker, S., Mayer, I., De Pasquale, G., Maier, W.,
Dirsch, O., De Groot, P. et al. (2001) Stent coating
with titanium-nitride-oxide for reduction of neointimal
hyperplasia. Circulation 104: 928—933.
Yin, M., Yuan, Y., Liu, C., Wang. and J. (2009)
Combinatorial coating of adhesive polypeptide and
anti-CD34 antibody for improved endothelial cell
adhesion and proliferation. J Mater Sci Mater Med
20: 1513—1523.
http://tau.sagepub.com