[Individualized patient care with urological implants using biofilm-resistant surface concepts]

Urological implants in the urinary tract are routinely used to ensure urine flow. However, the morbidities are numerous concerning long-term derivations. Especially with the ureteral stents, failure can have considerable consequences. Since the surfaces of all urological implants are more or less ideal substrates for microorganisms, the formation of bacterial biofilms is a regularly observed and often serious complication, which in many cases forces early implant replacement. The burden on the patient and the health system are enormous. This article provides an overview of the numerous strategies developed or under development to protect against bacterial adhesion. Observations in use show "sometimes good, sometimes bad results" for all strategies, which may be due to the fact that the treated patients have different biological and clinical conditions. The implants are each equipped with defense mechanisms designed for certain "scenarios"; if they are used inadequately in this respect, they cannot optimally fulfill their task. Systematic observations of the "outcomes" and evaluation of the obtained data would be necessary in order to be able to assign an "optimal" effect spectrum to each defense strategy, thus, ultimately prospectively giving patients the most suitable product in advance. Systematic use of the existing implant concepts can avoid a large number of implant-related complications "ad hoc"; further development steps with regard to improved surface modifications can be made more specifically. However, the hope of a "super strategy" is likely to remain unfulfilled because bacteria as "opponents" have already proved billions of years of survival.