title: Novel Biocompatible Adhesive for Intrarenal Embedding and Endoscopic Removal of Small Residual Fragments after Minimally Invasive Stone Treatment in an Ex Vivo Porcine Kidney Model: Initial Evaluation of a Prototype.
abstract: Residual fragments related to endoscopic intracorporeal lithotripsy are a challenging problem. The impact of residual fragments remains a subject of discussion and growing evidence highlights that they have a central role in recurrent stone formation. Therefore, we developed a novel bioadhesive system for intrarenal embedding and retrieval of residual fragments after endoscopic lithotripsy in an ex vivo porcine kidney model.
  
  
  
  In a standardized setting 30 human stone fragments 1 mm or less were inserted in the lower pole of an ex vivo porcine kidney model. We assessed the extraction efficacy of flexible ureteroscopy using the bioadhesive system in 15 preparations and a conventional retrieval basket in 15. Outcomes were compared regarding the endoscopic and macroscopic stone-free rate, and overall time of retrieval.
  
  
  
  Embedding and retrieving the residual fragment-bioadhesive complex were feasible in all trial runs. We observed no adverse effects such as adhesions between the adhesive and the renal collecting system or the instruments used. The stone-free rate was 100% and 60% in the bioadhesive and conventional retrieval groups, respectively (p = 0.017). Mean retrieval time was significantly shorter at 10 minutes 33 seconds vs 36 minutes 56 seconds in the bioadhesive group vs the conventional group (p = 0.001).
  
  
  
  This novel method involving adhesive based complete removal of residual fragments from the collecting system has proved to be feasible. Our evaluation in a porcine kidney model revealed that this technology performed well. Further tests, including inpatient studies, are required to thoroughly evaluate the benefit and potential drawbacks of bioadhesive based extraction of residual fragments after intracorporeal lithotripsy.
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany. Electronic address: simon.hein@uniklinik-freiburg.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Hein
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schoenthaler
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Wilhelm
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schlager
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Thiel
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Brandmann
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Richter
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Grunwald
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wetterauer
authors.affiliation: Department of Urology, Medical Center, University of Freiburg, Freiburg, Germany; Department of Adhesive Bonding Technology and Surfaces, Fraunhofer Institute for Manufacturing Technology and Advanced Materials (KT, MB, KR, IG), Bremen, Germany.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Miernik
mesh_terms: D000269:Adhesives; D000818:Animals; D001672:Biocompatible Materials; D004195:Disease Models, Animal; D005260:Female; D007669:Kidney Calculi / Q000473:pathology* / Q000628:therapy*; D008096:Lithotripsy; D013552:Swine; D018666:Ureteroscopy
chemical_list: D000269:Adhesives; D001672:Biocompatible Materials
keywords: adhesives; kidney; lithotripsy; ureteroscopy; urolithiasis