XPS and SEM detection of surface changes on 64 ureteral stents after human usage

Ureteral stents are commonly implanted to assist the postsurgery flow of urine from the kidney to the bladder. We hypothesized that different surface compositions of stent material could result in different conditioning film depositions and potentially altered receptivity to bacterial biofilms. Using XPS, three types of ureteral stents recovered from 64 patients were found to have adsorbed conditioning films that altered the surface composition of the devices. Elements associated with encrustation (calcium, magnesium and phosphorus) were found on 69% of the silicone latex stents, 44% of the low surface energy (LSe) devices, and 38% of the carbon-rich stents. No statistical difference was found in relation to patient gender, stent type, duration of implantation, and encrustation deposition. The composition of the film suggested that the nature of the underlying material did not significantly alter the elements that adsorbed. Thus, devices may take on a similar surface coat within days, and perhaps hours, of exposure to the host. With respect to dense encrustations, fewer appeared on the LSe devices. SEM confirmed the presence and nature of the film crystals and showed bacterial biofilms adherent to devices and encrustations in three patients who had received prophylactic trimethoprim compared to one on ciprofloxacin. In conclusion, although encrustation deposition and biofilm formation on ureteral stents is not unique to Cook devices, the human model and surface science test systems described here are invaluable to evaluate biomaterials used in patients. Unless biomaterials undergo rigorous analysis in vivo, including true assessment of the outcome of prophylactic antibiotic usage, clinicians will be unable to accurately select the best device and management strategy for a given patient.