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About Complications
Associated with Urological Devices
Urinary tract infections affect the
performance of the medical device. A major complication in the
care of patients undergoing long-term indwelling bladder
catheterisation is the deposition of crystalline bacterial biofilm
on the catheter. This encrustation causes trauma to the bladder
mucosa and can obstruct the flow of urine through the catheter
with potentially disastrous consequences to the patient.
The prevention and treatment of
biofilms on urological devices has focused on the surface
properties of the biomaterial itself or the development and
application of surface coatings to interfere with the bacterial
attachment to the biomaterial. The most studied surface coating in
urology is the silver-coated urethral catheter, which has been in
use for more than 20 years. A wide range of antimicrobial agents
have been coated onto urological devices in a bid to reduce
bacterial colonisation, including gentamicin, cefazolin and
nitrofurazone.
Research and development is
essential to overcome many of the complications associated with
current urological devices. The morbidity caused to patients and
the costs to healthcare systems resulting from the use of long
term indwelling urinary catheters is unacceptable. Simply applying
antimicrobial compounds or coatings that inhibit bacterial
adhesion are unlikely to have any long term effect on bacterial
colonisation. The basic design of the catheter needs to be
studied; smoother surfaces, better eyeholes and wider internal
lumens will improve the performance of the catheter. A redesign of
the device is required to enable complete emptying of the bladder
and prevention of the sump of urine, and the introduction of
mechanisms to maintain the normal cyclical filling and emptying of
the bladder. This is a huge challenge in an area of medicine that
is often neglected.
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