Drug Eluting Devices in the Urinary Tract

Abstract

AbstractThe obstruction of the upper urinary tract represents a common medical condition which could be related to significant and life-threating complications such acute renal failure and urosepsis. Ureteral stents are commonly used to prevent and manage such complications. However, the use of standard stents involves significant comorbidities, including stent-associated infection, encrustation, migration, urothelial hyperplasia reaction. Also, urethral strictures represent a common cause of lower urinary tract obstruction with the characteristic of frequent recurrence. Patients suffering from urethral strictures can be treated by minimally invasive techniques such as mechanical dilatation with balloon or placing of urethral stents. In attempt to address the any stent-related complications, the urological research considered ideas and concepts used in interventional cardiology and radiology. Percutaneous transluminal coronary angioplasty (PTCA) is the gold standard for coronary revascularization, even if restenosis complications exist in concerning rates. To address this complication, stents bearing drugs agents (most commonly immunosuppressive agents) have been used. These drug-eluting stents (DESs) release single or multiple bioactive agents, which are deposited on adjacent tissues. The immunosuppressive substances reduce benign tissue proliferation and their use has significantly reduced restenosis rates after PTCA. In a similar fashion, the drug-coated balloons (DCBs) are used as a new alternative instead of DESs in selected cases and offer important advantages. Their drug is released directly at the site of the stricture while avoiding any foreign material at the site of the stricture. Unfortunately, possibility of using DCBs in endourology is also under research.