wireless capsule endoscopy

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Article of the week: Preventing biofilm in wireless capsule bladder endoscopy

May 29, 2013/1 Comment/by admin Z.9

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video of in-vivo trials in sheep .

If you only have time to read one article this week, it should be this one.

Novel anti-biofilm mechanism for wireless capsule endoscopy in the urinary tract: preliminary study in a sheep model

Amos Neheman*^†, Claude Schulman^‡ and Ofer Yossepowitch^†§

*Urology Department, Meir Medical Center, Kfar-Saba, ^†Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, ^‡Department of Urology, University of Brussels, Brussels, Belgium, and ^§Institute of Urology, Rabin Medical Center, Beilinson, Petah Tikva, Israel

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OBJECTIVE

• To develop and test the safety and feasibility of a novel anti-biofilm mechanism configured for wireless capsule endoscopy (WCE) in a sheep bladder model.

MATERIALS AND METHODS

• A WCE mechanism, designed for long-term bladder monitoring, was developed and introduced into a sheep bladder for 5 months.

• The transparency of the surface was assessed by evaluating a resolution target placed inside the capsule at serial intervals using cystoscopy under general anaesthesia.

• Animal behaviour, voiding patterns and urine cultures were monitored throughout the study.

• At study termination, the capsule was extracted and assessed using scanning electron microscopy.

RESULTS

• The resolution target was visualized clearly at all investigation points.

• No notable adverse effects were noted during the entire follow-up period and no urinary tract infection occurred.

• Scanning electron microscopy confirmed the efficacy of the technology to prevent biofilm formation and surface encrustation.

CONCLUSIONS

• We report a novel technology that effectively prevents biofilm formation on the outer surface of foreign objects in the urinary tract.

• Further studies are under way to test the applicability of this technology in bladder WCE to enable high-quality wireless image transmission.

Read Previous Articles of the Week

Editorial: A promising solution for biofilm inhibition in the bladder, but is the application of wireless capsule cystoscopy practical?

May 29, 2013/1 Comment/by Jeffrey Cadeddu

The study by Neheman et al. follows up on an idea first proposed in 2009 by Gettman and Swain to adapt wireless capsule endoscopy (WCE) technology for cystoscopy. Unlike the gastrointestinal tract where the small bowel is not endoscopically accessible making WCE appealing and advantageous, the idea of wireless capsule cystoscopy (WCC) competes with a minor procedure, office cystoscopy, that does not require anaesthesia or sedation and takes only a few minutes to perform. Furthermore, although the authors suggest that WCC would shift the labour associated with bladder cancer monitoring from practising urologists to ancillary health team providers, flexible office cystoscopy is a procedure already routinely performed by physician extenders in many offices. Nevertheless, the concept proposed by Neheman et al. is innovative and intriguing. The potential advantage of a wireless capsule cystoscope placed in the bladder safely for up to a 2-year time period, and thereby reducing the inconvenience and cost of repeated cystoscopies, could be a significant advance.

It should be emphasized that despite the title, no WCE was actually performed. The real value to the present study is the novel anti-biofilm mechanism developed that would be needed for any device implanted in the bladder for the long term. The device was housed in a semi-permeable silicone balloon filled with mineral oil that allowed a continuous slow diffusion of oil across the membrane. Based on the evidence provided in only one animal, it seems this continuous permeation of oil can interfere with surface protein adherence and consequently bacteria adhesion and biofilm creation. Certainly, this concept needs to be tested further in additional animals, aggressively exposed to bacteria, and for longer periods.

Although I am unconvinced that the concept of WCC provides significant value, the development of this biofilm inhibition technique could be pioneering. I read this study and wondered if ureteric stents and Foley catheters could be designed and impregnated with mineral oil to be released gradually. Perhaps the balloon of a Foley catheter could be redesigned and filled with mineral oil that is then released along the catheter’s entire length in a similar fashion. The true Holy Grail is the prevention of encrustation and biofilm formation on these relatively mundane devices whose chronic exchange for many patients is more costly than bladder cancer surveillance. I look forward to additional work from the authors exploring the potential of this technology.

Jeffrey A. Cadeddu
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

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Video: In-Vivo Trials in Sheep

May 29, 2013/by admin Z.9