Response to Tailly and Van Haute: In Vitro Effects of a Novel Coating Agent on Bacterial Biofilm Development on Ureteral Stent by Schoeb et al. (From: Tailly T,Van Haute C. J Endourol 2019;33:232–233;DOI: 10.1089/end.2018.0907)

Dear Editor:

The authors of the publication would like to express their sincere gratitude to Thomas Tailly and Carl Van Haute for the editorial. The ongoing development of technologies that improve the biocompatibility of urogenital implants is of utmost importance. Particularly in the field of ureteral catheters, major clinical challenges have been observed in patients requiring long-term urinary drainage. Despite intense efforts and testing of various coating materials, bacterial implant colonization in the urinary tract remains largely an unsolved problem. Tailly and Van Haute addressed a crucial aspect in their editorial. So far, little is known and not much research has been done on the factors that lead to the early microbial colonization of ureteral catheters. At least four main determinants play a decisive role here: (1) the material and coating of the stent itself, (2) the patient's own bacterial flora of the urinary tract, (3) the duration of stenting, and (4) biophysiologic processes and anatomy of the urinary tract (amount and composition of urine, urine transport, storage and emptying function of the urinary bladder, etc.). ^{1 –8} All these points illustrate the complexity of the problem at hand and explain why research on the improvement of urologic stents is progressing at a slow pace. Our work has tackled only a limited section of the wide range of possible approaches that might contribute to reducing biofilm formation on ureteral implants. We will continue our investigations knowing that the path to success is a long one. The economic aspects must also be taken into account. This includes public funding of research projects in this field as well as the willingness of industrial partners to transfer new results into product development. Nevertheless, we see these efforts as being worthwhile and hope to make an important contribution to improve health care in urologic patients.