Fluid structural analysis of urine flow in a stented ureter

Many urologists are currently studying new designs of ureteral stents to improve the quality of their operations and the subsequent recovery of the patient. In order to help during this design process, many computational models have been developed to simulate the behaviour of different biological tissues and provide a realistic computational environment to evaluate the stents. However, due to the high complexity of the involved tissues, they usually introduce simplifications to make these models less computationally demanding. In this study, the interaction between urine flow and a double-J stented ureter with a simplified geometry has been analysed.The Fluid-Structure Interaction (FSI) of urine and the ureteral wall was studied using three models for the solid domain: Mooney-Rivlin, Yeoh, and Ogden. The ureter was assumed to be quasi-incompressible and isotropic. Data obtained in previous studies fromex vivo and in vivo mechanical characterization of different ureters were used to fit thementioned models.The results show that the interaction between the stented ureter and urine is negligible. Therefore, we can conclude that this type of models does not need to include the FSI and could be solved quite accurately assuming that the ureter is a rigid body and, thus, using the more simple Computational Fluid Dynamics (CFD) approach

Numerical Study of Fully Coupled Fluid-Structure Interaction of Stented Ureter by Varying the Stent Side-Holes

Ureteral stents are a measure used for many medical issues involving urology, such as kidney stones or kidney transplants. The purpose of applying stents is to help relieve the urine flow while the ureter is either blocked or trying to close itself, which creates blockages. These ureteral stents, while necessary, cause pain and discomfort to patients due to them being a solid that moves around inside the patients’ body. The ureter normally moves urine to the bladder through peristaltic forces. Due to the ureter being a hyperelastic material, these peristaltic forces cause the ureter to deform easily, making it necessary for the stent to properly move the urine that flows through it for the patient not to face further medical complications. In this study, we seek to find a relation between the amount of stent side holes and the overall flow rate inside the stent with the ureter contracting due to peristalsis. A fully coupled fluid-structure interaction (FSI) model is developed to visualize how the ureter deforms due to peristalsis and the subsequent effect on the urine flow due to the ureter’s deformation. Numerical simulations using COMSOL Multiphysics, a commercial finite-element based solver, were used to study the fluid-structure interaction, and determine whether the stent performs more properly as the amount of stent side holes increases. The results showed that the stent model with a 10 mm distance between side hole pairs provided the highest outlet flow rate, which indicates a proper stent design that allows for maximized urine discharge. We hope this study can help improve the stent design in kidney transplant procedures to further ease the inconvenience on the patients

Flow Dynamics in Stented Ureter

Urinary flow is governed by the principles of fluid mechanics. Urodynamic studies have revealed the fundamental kinematics and dynamics of urinary flow in various physiological and pathological conditions, which are cornerstones for future development of diagnostic knowledge and innovative devices. There are three primary approaches to study the fluid mechanical characteristics of urinary flow: reduced order, computational, and experimental methods. Reduced-order methods exploit the disparate length scales inherent in the system to reveal the key dominant physics. Computational models can simulate fully three-dimensional, time-dependent flows in physiologically-inspired anatomical domains. Finally, experimental models provide an excellent counterpart to reduced and computational models by providing physical tests under various physiological and pathological conditions. While the interdisciplinary approaches to date have provided a wealth of insight into the fluid mechanical properties of the stented ureter, the next challenge is to develop new theoretical, computational and experimental models to capture the complex interplay between the fluid dynamics in stented ureters and biofilm/encrustation growth. Such studies will (1) enable identification of clinically relevant scenarios to improve patients’ treatment, and (2) provide physical guidelines for next-generation stent design

Computational simulation of the flow dynamic field in a porous ureteric stent

Ureteric stents are employed clinically to manage urinary obstructions or other pathological conditions. Stents made of porous and biodegradable materials have gained increasing interest, because of their excellent biocompatibility and the potential for overcoming the so-called ‘forgotten stent syndrome’. However, there is very limited characterisation of their flow dynamic performance. In this study, a CFD model of the occluded and unoccluded urinary tract was developed to investigate the urinary flow dynamics in the presence of a porous ureteric stent. With increasing the permeability of the porous material (i.e., from 10−18 to 10−10 m2) both the total mass flow rate through the ureter and the average fluid velocity within the stent increased. In the unoccluded ureter, the total mass flow rate increased of 7.7% when a porous stent with permeability of 10−10 m2 was employed instead of an unporous stent. Drainage performance further improved in the presence of a ureteral occlusion, with the porous stent resulting in 10.2% greater mass flow rate compared to the unporous stent. Findings from this study provide fundamental insights into the flow performance of porous ureteric stents, with potential utility in the development pipeline of these medical devices. Graphical abstrac

The interplay between bacterial biofilms, encrustation, and wall shear stress in ureteral stents: a review across scales

Ureteral stents are hollow tubes that are inserted into the ureter to maintain the flow of urine from the kidney to the bladder. However, the use of these indwelling stents is associated with potential complications. Biofilm, an organized consortium of bacterial species embedded within a self-producing extracellular matrix, can attach to the outer and inner surfaces of ureteral stents. Furthermore, encrustation - defined as the buildup of mineral deposits on the stent surface - can occur independently or in parallel with biofilm formation. Both phenomena can cause stent obstruction, which can lead to obstructive pyelonephritis and make stent removal difficult. Understanding the influence of flow on the development of biofilm and encrustation and the impact of small mechanical environmental changes (e.g., wall shear stress distribution) is key to improve the long-term performance of stents. Identifying the optimal stent properties to prevent early bacterial attachment and/or crystal deposition and their growth, would represent a breakthrough in reducing biofilm-/encrustation-associated complications. This review identifies the most prevalent bacterial strains and crystal types associated with ureteral stents, and the process of their association with the stent surface, which often depends on patient comorbidities, stent material, and indwelling time. Furthermore, we focus on the often-overlooked role of fluid dynamics on biofilm and encrustation development in ureteral stents, across a range of physical scales (i.e., from micro- to macro-scale) with the aim of providing a knowledge base to inform the development of safer and more effective ureteral stents

Urinary Stents

This open access book provides a concise overview of a range of aspects related to urinary stents. Sections within the work cover clinical and recent technological advancements in the field. Chapters feature detailed coverage of the different surgical, pharmacological and palliative treatments currently available. Insight is also given on current limitations of urinary stents and how these can be overcome by utilizing anti-biofilm coatings; new biomaterials, drug-eluting stents, and biodegradable stents. Therefore, enabling the reader to systematically gain a detailed understanding of the subject. Urinary Stents is a practical, multi-disciplinary focused resource on the complications and applications of ureteral, urethral and prostatic stents in day-to-day clinical practice. A vital read for all medical professionals and researchers who work in this area

Nanoparticles: Potential for Use to Prevent Infections

One of the major issues related to medical devices and especially urinary stents are infections caused by different strains of bacteria and fungi, mainly in light of the recent rise in microbial resistance to existing antibiotics. Lately, it has been shown that nanomaterials could be superior alternatives to conventional antibiotics. Generally, nanoparticles are used for many applications in the biomedical field primarily due to the ability to adjust and control their physicochemical properties as well as their great reactivity due to the large surface-to-volume ratio. This has led to the formation of a new research field called nanomedicine which can be defined as the use of nanotechnology and nanomaterials in diagnostics, imaging, observing, prevention, control, and treatment of diseases. For example, coverings or coatings based on nanomaterials are now seen as a promising strategy for preventing or treating biofilms formation on healthcare kits, implants, and medical devices. Toxicity, inappropriate delivery, or degradation of conventionally used drugs for the treatment of infections may be avoided by using nanoparticles without or with encapsulated/immobilized active substances. Most of the materials which are used and examined for the preparation of the nanoparticles with encapsulated/immobilized active substances or smart reactive nanomaterials with antimicrobial effects are polymers, naturally derived antimicrobials, metal-based and non-metallic materials. This chapter provides an overview of the current state and future perspectives of the nanoparticle-based systems based on these materials for prevention, control, or elimination of biofilm-related infections on urinary stents. It also addresses manufacturing conditions indicating the huge potential for the improvement of existing and development of new promising stent solutions

Urinary Stents

This open access book provides a concise overview of a range of aspects related to urinary stents. Sections within the work cover clinical and recent technological advancements in the field. Chapters feature detailed coverage of the different surgical, pharmacological and palliative treatments currently available. Insight is also given on current limitations of urinary stents and how these can be overcome by utilizing anti-biofilm coatings; new biomaterials, drug-eluting stents, and biodegradable stents. Therefore, enabling the reader to systematically gain a detailed understanding of the subject. Urinary Stents is a practical, multi-disciplinary focused resource on the complications and applications of ureteral, urethral and prostatic stents in day-to-day clinical practice. A vital read for all medical professionals and researchers who work in this area