The present invention relates to a hydrophilic, water- swellable graft copolymer and to surgical αevices incor¬ porating said graft copolymer.

Synthetic polymeric materials have been employed for a wide variety of surgical devices for m y years. For example polyvinyl chlorides, polytetraf luoroethylene, polyarαides , polyethylenes and silicone rubbers have been utilised as catheters and cannulae (for the introduction or draining of various fluids), as dilators and connectors as well as for implantation into or onto living mammalian bodies. Host of the devices and the materials from which they are made have performed their intended purpose at least adequately • In a number of cases however the availa¬ bility of a material (for such surgical devices) that was capable of swelling to a high degree in aqueous media, whilst, in its hydrated form, retaining its integrity and exhibiting slippery surface characteristics, would greatly facilitate medical treatment .

A number of water -εwe liable materials are known which are suitable for medical applications, such as hydrophilic gels (hydrogels), some of which take up many hundreds of percent

of their own weight of water but are generally slow to reach equilibrium and are quite weak on full hyάration . Some are non-cyclable ie cannt be dried fully and then r eswo ilen to their former dimensions .Some are unsuitable for tubular geometry in the swollen , weak state and unable to exert the requir ed pressure for maintenance of lur.en .0n hydration hydrogeis of tubular structure are like ly to give rise to a decrease rather than an increase in internal diameter . Kydrog els therefore need to be coated or grafted to supports for strength . To allow the complete structure to swell however a bulk graft is required and the limitat¬ ions on swelling" are thus governed by the backbone polymer .

It is one object of the present invention to provide novel graft copolymer s that meet these further requirements , whilst overcoming the difficulties encountered with known water swe liable materials .

It is a further object of the present invention to provide devices incor orating these novel graft copolymers , parti c¬ ularly surgical devices . According to a first aspect of the present invention a hydrophilic water -swe liable graft copolymer comprises polyethylene vinyl acetate (P3VA ) , containing between 8 and 30 weight percent vinyl acetate units , radiation graft co polymerised with an ethylenic carboxylic acid and subseq- uently heat treated in an aqueous hydroxide so lution at a temperature above the softening point of the P3V . According to a second aspect of the present invention there is provided a process for the preparation of a hydrophilic water -swellable graft copolymer comprising radiation graft

copolyr.erising polyethylene vinyl acetate (PΞVA) containing between 8 and 30 weight percent of vinyl acetate units, with an ethylenic carboxylic acid, and subsequently heat treating the graft copoy erised PEVA in an aqueous hydroxide solution at a temperature in excess"' of the softening point of the PEVA •

The terms 'polyethyle e vinyl acetate' and 'PEVA' used her¬ ein refer to copolymers of ethylene and vinyl acetate. hese may comprise purely ethylene and vinyl acetate units or may 0 may comprise polymers consisting substantially of ethylene and vinyl acetate units together with small quantities of additives such as propylene which may be present in commerc¬ ially available PEVA.PΞVA is available commercially contain¬ ing up to about 40 percent by weight of vinyl acetate units 5 but the inventors have found that the upper limit to achieve workable strength in the polymers of the invention without crosslinking is 30 ?■ by weight...

The percentage of vinyl acetate units in the PΞVA is one of the factors determining the crystallinity of the PΞVA, and C the inventors have noted that in the samples of PΞVA pres¬ ently available those containing 8 wt, % of vinyl acetate units generally are about 35 wt.% crystalline, the crystal- inity decreasing with increasing vinyl acetate content.

The preferred ethylenic carboxylic acids are acrylic acid or 5 an alkyl subεtitued acrylic acid, especially methacrylic acid.

In many cases the PΞVA may be pre-for ed in a desired shape, eg. sheet, tube, solid, prior to graft copolymerisation. However it is also possible for the graft copolymerised

polymer to be formed as required, or even, in some embodim¬ ents of the present invention, for the heat treated polymer to be shaped, by, for example slowly drying the hydrated material over a former .Whichever method of shaping the at- erial is chosen, the shape is retained on subsequent hydr- ation of the heat treated material.

Furthermore in the great majority of cases the PΞVA is uni¬ formly graft copolymerised throughout the bulk of the polymer (bulk graft copolymerisation) or throughout selected parts of the bulk of the polymer (selective bulk graft copolym¬ erisation) .Surface graft copolymerised PΞVA in which he polymer is graft copolymerised to a known depth fror. its surface on any one or more of its surfaces, may hovever have important though limited uses. The graft copolymerisation reaction is preferably carried out in a suitable solvent for the ethylenic carboxylic acid, although, par.ti.cu.la ly where it is only necescary to carry out a surface graft co olymerisation., the reaction may be carried out in the absence of any solvent, ie in undiluted acid. The prefersd solvent for the acid is water, however other solvents such as ethanol or acetone may be used without adverse effect on the product .Preferably the percentage of acid in the solvent is between 2 and 50 percent by volume. Chain transfer agents, free radical scavengers and/or ho o- polymerisation inhibiting agents of the type well known in the graft copolymerisation art may also be present during the graft copolymerisation.

In a preferred embodiment of the present material and pro¬ cess the graft copolymerisation takes place in an aqueous

solution of an ethylenic carboxylic acid containin a homo- polymerisation inhibitor selected from cupric chloride, cupric nitrate, certain organic inhibitors, or, which is particularly preferred, ferrous sulphate or potassium err- icyanide.

Initiation of the graft copolymerisation is preferably eff¬ ected by ionising radiations, especially high energy gaιr.ma radiation, although othe radiations eg ultraviolet, light or heat may be used where appropriate .Where initiation is by ionising radiations such as gamma rays cr accelerated elect-

5 rons, the absorbed dose is preferably between 1 x 10 and

6 3 x 10 rad based upon a G Ferric ion for the Fricke Dos- ^• i eter of 15-6.

It is desirable to remove any dissolved gases such as air from the solut n prior to the graft copolymerisation so as to avoid the formation of bubbles on the surface of the ^Ξ which might restrict access of ^" the ethylenic carboxylic acid to the surface and result in non-uniform copolymerisation.

The percentage graft copolymerisation (percent weight of ethylenic carboxylic acid in total weight of product actual- -ly copolymerised, ie in surface graft copolymerised mater¬ ials only the weight of the copolymerised regions is counted) is generally chosen so as to maximise the aqueous swelling characteristics of a given material according to the inven- -tion.The percentage is preferably between 20 and 6θ ^β /o ^~ oγ weight for both bulk and surface graft copolymerised mater¬ ials.

Following graft-copoly erisation the graft copolymerised material is separated from, the rest of the reaction mixture

and preferably washed in distilled water, and dried. The graft copolymerised material is then subjected to a heat treatment in an aqueous hydroxide solution at a temperature in excess of the softening point of the PΞVA, and preferably o in excess of 80 C.The preferred source of hydroxide ion is potassiUE hydroxide, whilst the hydroside concentration in the heat treatment medium is preferably between 0. Ill and

10IT, especially between 0.1 and 0-5K«The most preferred heat treatment medium is a 0.5 to 1.5H aqueous solution of _Q potassium hydroxide.

The heat treatment temperature must be above the softening o point of the P^'VA and is preferably above 80 C.The exact temperature of heat treatment however is determined by the particular properties (swelling, slipperiness for example) 5 required of the final product .Similarly the time that the graft copolymerised PΞVA is immersed in the heat treatment medium is determined by the properties required of the final product, as well as by the tnickness of the material undergoing heat treatment and the medium. used for the o heat treatment. In the experience of the present inventors the time can be measured in minutes ra'-her than hours.

After heat treatment the medium is removed and the treated material is preferably washed with distilled water and dried.

For best results this drying should be carried out slowly, o o 5 especially at a temp rature between 4θ C and 60 C, particu- o larly of about 50 C.

The graft copolymers of the present invention swell to an equilibrium extent within a few minutes of wetting, and is generally fully cyclable.The sp ed of swelling may e red-

uced by for example restricting the access of water to the surface by for example coating the copolymer with a partially water resistant, or water-soluble layer, which may be a water soluble polymer. According to a third aspect of the present invention there is provided a device made wholly or partly of a hydrophilic water swellable graft copolymer according to the present invention • .

Such a device may be intended for any appropriate commercial or industrial use, and may have any geometry appropriate for such use. particularly preferred form of such a device is a tube, which on wetting expands providing both an increased external diameter and an increased internal bore. Such a tube may ^' have at least one closed end. Particular advantages may be achieved by making a device according to the invention in which parts of the device swell to different extents., on wetting. Such differential swelling may for example comprise. (i) The swelling of some parts whilst other parts do not sweϋl.This may be achieved by selective bulk copolymerisation of only those parts of the device where swelling is required. (ii) The swelling of different parts of the device to dif- erent extents. his may be achieved by varying the regime of the process of the invention in different parts of the device, for example :.ome parts of the device may be subjected to a longer or hotter heat treatment .

(iii) Graded swelling. For example a smooth gradation of extent of swelling from non-swelling to swelling .This ;:.ay for example be achieved by varying the regime of the process of the invention in different narts of the device in a

graded manner .

The precise processing regime to achieve a desiBEd differ¬ ential extent of swelling m _a be determined experimentally. Any device may include one or more of the types of difϊ ^' eren- tial swelling exemplified in (i) to (iii) above.

Particular advantages may also be achieved by introducing reinforcing elements into such a device, so as to further increase the strength of the device in either or both its dry or swollen states .Suitable reinforcements may be intro- duced for example by co -extrusion of the PΞVA with other materials having greater strength or rigidity, or by the introduction of reinforcing fibres, filaments or wires into either the body of the device or into a suitable cavity in the device. A device according to the invention nay be coated as descr¬ ibed above to reduce the speed of swelling.

The main use, as presently envisaged , of the copolymers of the present invention is in the medical field, where the combination of a high water -swelling characteristic, slip- periness and retention of integrity will be particularly advantageous.

Accordingly, in a fourth aspect of the -resent invention, there is provided a surgical device m de wholly or partly from a hydrophilic, water-swellable graft copolymer accor- ding to the present invention.

The term 'surgical' as used herein is intended to include both human and veterinary surgery.

Smooth surface properties of medically used polymers are an accepted feature of enhanced biotol --ranee and resistance to encrustation .Scanning electron microscope examination

of the surface properties of dry and water-swelled copoly¬ mers of the present invention have shown that the surface of the water-swelled copolymer compare favourably with the dry surface of pure medical grade polydimethylsilane , The cytotoxicity of PΞVA was assesed br elution, overlay and direct contact methods using pure cell cultures of I- ^' RC lung fibroblasts .Preliminary reports suggested equivalent cytotoxicity of PΞVA to medical grade latex .The hypertoπ-icity of the culture medium caused by the hydrophilicity of PΞVA caused difficulty in the interpretation of these results; with refined techniques of culture and elution it is to be expected that PΞVA would compare favourably with polydineth- ylsiloxane in terms of cytotoxicity.

The preferred compositions of and processes of preparing the graft copolymers employed in the present surgical devices are the same as those set out above in the description of the graft copolymer and the process of preparing the same, As before the final shape of the graft copolymer (and in this case the surgical device) may be attained prior to graft copolymerisation, after graft copolymerisation or after heat treatment. ..

Surgical devices according to the present invention may utilise either bulk, selective bulk or surface graft copol¬ ymerised materials as described above. Such devices :.;ay also have parts which swell to different extents, agaain as des¬ cribed above .They may also incorporate reinforcing elements as described above, but in this case the material(s) used for reinforcing should comply with body and bodily fluid contacting clinical regulations ap-ropriate to their inte- nded use.

In surgical applications particularly it may be advantageous to reduce the speed of swelling on wetting by the application of a coating as described above .For example, if a graft co¬ polymer of the present invention were used in a urethral or ureteric catheter a short swelling time would be a disadva¬ ntage. It would be advantageous to retain the relative stiffr- ness of the unhydrated structure for a sufficient time to enable correct positioning and adjustment of the structure before swelling commences with attendant loss of stiffness. C To delay such swelling the structure may be coaled with a layer of water soluble polymer, which would dissolve over a given period of time depending upon the thickness of coating, type of polymer used or the application of cross-linking processes, so delaying the time for the structure to contact 5 the swelling mediu .Examples of polymers which may be used as such coatings include polyvinyl alcohols (?VA), polyvinyl pyrrolidines, polyethylene glycols and mixtures thereof. Any such polymer coating should be sufficiently biotolerable for there intended use, and may be applied to the surface of the structure by any means well known in the art, eg dipping into a solution of the polymer followed by drying. 3y using the graft copolymers of the present invention, sur¬ gical devices according to the invention may be espected to retain adequate structural strength in the wet swollen state 5 for a tubular device up to around 100% internal diameter change, but the required strength will of course depend upon the intended use.

Examples of surgical devices which may advantageously employ the present graft copolymers include the following:

ii i. Tubes for the passage of l parascopes and similar view¬ ing instruments into the peritoneal, retroperitoneal and mediastinal spaces. ii. Tubes to form a track through which a foreign body can be extracted without damage to the tissue of the track wall, iii . Urethral catheters which would be self-lubricating and would therefore not require the introduction of jelly prior to insertion. iv, Ξndovascular cannuli .In this case a selective bulk graft copolymerised material would have a rigid (:ιon-hεat treated) end which would act as an external Luer fillting for connect¬ ion to conventional equipment, and a water swellable (heat treated) end which would serve as the endovascular component. Thus a small cannula could be used for insertion (aiding the comfort of the patient) v. ^r hich would expand, after inser¬ tion to give a wide lumen, thereby enhancing naximi infus¬ ion rates. v. .Tephrostomy drain using a surface graft copolymerised material. vi . Tubes for use in percutaneous surgical techniques, in particular percutaneous nephroscopy.The introduction of such tubes into body cavities in the shrunken dry state would be followed by hyάration and expansion, thereby allow¬ ing access to the cavity from without .Using the present materials the passabe of instruments into and out of the body cavities would be enhanced, which in turn woμld reduce the trauma associated with non-lubricated stiffer tubing. In this way access to for example the ureter (through the urethra) and to the kidneys would be facilitated.

vii. Devices fcr the dilation of strictures, for example urethral, ureteric, biliary and oesophagal.In this case a device would be inserted into the duct or passage in which the stricture occurs, and on contact with bodily fluids

5 would exert peripheral pressure , dilating the stricture. viii. Store chutes .bridging the ureter to the urethra. ix. Artificial ureters x. Parenteral feeding. xi o Packing, support and filling in reconstructive surgery. C xii . Incontinence controlling devices. xiii. Ξndotrachael tubes, especially in infants. xiv. llasogastric feeding tubes in infants and adults. xv. All forms of endoscopic access. xvi . Ξn oprostheses, such as endo-uro, -biiary, -neurologi- 5 cal or -vascular .In this case insertion of an endo pro site sis made of a graft copolymer according to the present invention may pr-ovide an especial advant?: e in that its swelling and exertion of peripheral pressure may be utilised to allow the prosthesis to form a temporary or permanent bridge 0 accross a εcissional, diseased or hereditary gap in the lumen concerned.

The present graft copolymers, processes for preparing them and devices, including surgical devices incorporating them will now be described by way of example only. 5 Ξxaπn-l 1

A 38 π thick film of polyethylene vinyl acetate contain¬ ing ΛZ. % (by weight) vinyl acetate and of approx 25?ό crystsl- linity (supplied by ICI under the code number 555) was inter¬ leaved with an absorbent material and placed in a glass tube. θ The tube was filled with an aqueous monomer solution comprising 25% by volume of commercial grade stabilised acrylic acid and

g/l FeSO, (Analar Grade). The tube and contents were evacuated by water ump for - hrs to remove oxygen and then pressure equalised and sealed. The tube was irradiated with gamma rays from a 60 Co source at a dose rate of 0.011 Mr/hr to a total dose of 0.8 Mrad at 20°C. The graft-copolymerised film was washed in distilled water and dried at =0 C. The acrylic acid graft was homogenousand 31.5?a (by weight). The graft- copolymer was then subjected to a heat treatment consisting of 5 cins immersion in a % aqueous potassium hydroxide ^' solution at a temperature of 95 C, followed by a quench in distilled water at 20 C, rinsing in distilled water and drying at 50 C. Dimensional changes en subsequent water equilibration were measured and summarized as follows: fό Change Length Breadth Thickness eight

Ξxacrole 2

An 85 Ji thick polyethylene vinyl acetate film (supplied by ICI under the code number 24—03/51) containing 2 % (by weight) vinyl acetate and with approximately 15? crystallinity, together with antibloc agents, was graft-copolymerised as described in Example 1 but with a dose rate of 0.01 ^' 5' Mr/hr to a total dese of 1 Mrad. This gave an homogenous acrylic acid graft of 3 .6>o (by weight). Subsequent heat treatment was in the manner of Example 1 and gave the dimensional changes on water equilibration as summarized below. fo Change Length Breadth Thickness eight +82 +88 +130 +797 Example 3

A 300 um wall tubular structure of polyethylene vinyl acetate (supplied by ICI under the ;ode number 539) containing 18# (by weight) vinyl acetate and with approximately 20'^ cry¬ stallinity was graft-copolymerised as described in Ξxample 1. Total dose given was O.96 Mrad at a dose rate of 0.015 Mr/hr. This gave an homogenous acrylic graft of .0?. (by weight). Subsequent heat treatment as in Example 1 gave dimensional changes on water equilibration as given below.

f; Change

Length Internal Diameter V/eight

+62 +80 +377

Example k .

^•? An extruded tube (nominal internal diameter 5. mm and wall thickness 0.3mm) of polyethylene vinyl acetate containing 12.5fό (by v/eight) vinyl acetate (the PVA supplied by ICI under the code number 5"i*÷) was placed in a glass vessel. The tube was then immersed in an aqueous solution of acrylic acid

10 (25?& by volume) and ferrous sulphate ( g/i). The vessel and contents were then evacuated by water pump for 2 hrs to remove oxygen and then pressure equalised and sealed. The vessel was irradiated wi h gamma rays from a 60 Co source at a dose rate of 0.015 Krad/hr to a total dose of 1 Mrad at ••--' 21 C. The graft copolymerised tube was washed with distilled water (to remove unreac ed monomer or homopolymer) and then dried at 50 C. The graft weight was determined to be 39-7^ (by weight). The graft copolymerised: tube was then immersed for 5 mins in a y/o aqueous solution of potaεεium hydroxide

20 at 95 C. This was followed by a quench in distilled water at o o

20 C, rinsing in distilled water and drying at 50 C. Dimen¬ sional changes on subsequent water equilibration were measured and are summarized as follows:

% Change 25 Length Wall Thickness Internal Diameter Weight +53 +68 +43 +228

Example 5

The procedure of Example 1 was repeated except that the potassium hydroxide solution was replaced by a K aqueous 0 solution of sodium hydroxide. Example 6

The procedure of Example 1 was repeated except that the ferrous sulphate was replaced by 7g/l of potassium ferri- cyanide and the concentration of the potassium hydroxide 5 solution was 1.5M. Example 7

The procedure of Example 1 was repeated except: that the concentration of acrylic acid in the grafting solution was reduced to 12. (by volume) and the total dose of gamma

1 c radiation was increased to 1.2 Mrad. xample 8

The procedure of Example 5 was repeated except that the concentration of acrylic acid in the grafting solution was reduced to Λ≥.5% (by volume) and the total dose of gamma radiation was increased to 1Mrad

Example 9 (Comparative)

A 38 um low density polyethylene with a k^% crystallinity was subjected- to the graft copolymerisation and heat treatment described in Example 1. Dimensional changes on subsequent water equilibration were measured and are summarized as follows:

% Change

Length Breadth V/eight

+10g +25% +7

Example 10 (Comparative)

A 38 um thick film of polyethylene vinyl acetate contain¬ ing k% (by weight) vinyl acetate and of approx -+5-70 (by weight) crystallinity was treated as described in Example 1. Dimen- sional changes on subsequent water equilibration were measured and are summarized as follows:

Length Breadth V/eight- +313 +18 +9hfi

Example 11 The graft copolymerised, heat treated tube of Example 4 was used to remove a calculus from the left posterior lower calyx of a man suffering from renal colic.

On the day of admission, a 26 Ch (Ch = Charier = approx 0.33mm) nephrostomy track was dilated in a single sesεion under neurolept anaesthesia using a Lundaquist guide v/ire and serial Cook fascial dilators. A 26 Ch Porges whistle tip nephrostomy tube was then left in situ for 4 days. The track was sighted through the lower calyx and X-rays showed that it was placed adjacent to the stone. On the 4th day, in the X-ray Depart- ment, with the patient on a Siemens (Trade Mark) uniplanar fluoroscopic table and under inhalational general anaesthetic, track endoscopy was carried out.

A floppy J guide wire v/as passed down the nephrostomy tube which was subsequently removed. Using a Thackray

nephroscope with a preshrunk attached graft-copolymer tube (prepared as in Example 4) over its outer circumference the nephrocutaneous track was negotiated under direct vision using the wire guide as a directional aid. Following wetting of the graft-copolymer with saline, expansion occurred and the track was subsequently secured. The stone waε visualised and siezed with alligator forceps and pulled through the tubing. The - tube was then removed and the patient returned to the ward. Post operatively urography creatinine clearance and urine cultures were all normal. The patient returned home

48 hours after the procedure and was well on follow up at one month's time. Example 12

The graft copolymerised, heat treated tube of Example 4 was used to remove a calculus from the left renal pelvis of a man suffering from recurrent urinary tract infections and left loin pain.

Track dilatation was carried out under neurolept anaesthesia in the manner described in Example T*. On day 4, stone extrac- tion was performed with the patient in the prone oblique position.

A soft J guide wire was passed down the Porges whistle tip nephrostomy tube and this was then removed. A 25 Ch Cook fascial dilator, which had previously been perforated and onto which the graft-copolymer tube (prepared as in Example 4) had been shrunken, waε then passed over the guide wire into the kidney. Saline was poured into the central lumen of the dilator and this caused the tube to expand. The nephrocuta¬ neous track was thus protected and the dilator removed from the middle of the tubing leaving a track directly betv/een the skin and the kidney. A nephroscope (Thackray) was pasεed into the kidney and the stone identified. Using the Wolf ultrasonic

lithotriptor, on setting 3 _ι the stone v/as reduced to fragments over a period of an hour. These were extracted through the tube with alligator forceps under direct vision. After the successful conclusion of the operation the tube was removed and the patient returned to the ward.

He was able to return home on the 2nd post operative day, no ill effects were noted and urine cultures were sterile. He was well at follow up at one month's time.

The expansion tubing prepared as in Example 4 has the ability to stretch in the hydrated form and so allow the passage of calculi larger than the internal diameter of the established track. This would not be possible with currently available rigid tubing.

Example 15

15 '. Example of tubular structure coated to decrease the swelling speed . A tubular structure as described in Example

3 above was coated with polyvinyl alcohol by dip coating with a 15 wt , %aqueous so lution of po lyvinyl alcohol of o molecular weight 14 , 000 fo llowed by drying at 50 C . he time

20 to reach equi librium swelling in 7fater was incr eased to about 30 minutes compared with about 3 minutes for the uncoated tube . Example 14

A tubular structure of Imπ internal diameter and

25 300 urn wa ll thickn ess of po lyethylene vinyl acetate (suppl¬ i ed by ICI under the code number 554) containing 12 .5 % by weight of vinyl acetate was graft copo lymerised and heat treated as _' - es cribed in example 4. ota l do se given was 1 Hrad at a dose rate of 0 .015 Urad/hr to give a graft of C 33 .5 % by weight . Dimensional changes on water equi libration

Iδ were:

% Change Len th Internal Diameter Wall Thickness 7? ei ht

+ 45 +43 + 68 + 257 Example 15

Tubes (stents) coated with polyvinyl alcohol prepared as described in Example 15 were implanted into the left ureter of 12 i-άnipigs .The right ureter was used as a control. Currently used stents of medical grade polymers were impl- anted into the left ureter of a furthsr 16 mlnip:.gs ( 8 po- lyu ethane stents and 8 pure polydinethylsiioxane stents) . The histological appearence of the uretic epithelium was assessed after contact with each polyner for periods of 1 week, 2 weeks, 2 months a nd 3 months. In ail cases there was a tendency to mucous dysplasia in the transitional cell epithelium .This change was comparable in all groups. _^ E ample 16

The rabbit urinary tract, in which calcium carbonate crystallises on all non-degradable biomaterials within one week of implantation, was chosen to compare the rate and degree of encrustation on stents of polydi ethylsiloxane (3) polyvinylchloride (6) polyamide (3) and a copolymer accord¬ ing to the invention (3) .The results are shown below. The copolymer compared favourably with polydimethylsiloxane. The stents were analysed "ay X-ray energy spectroscopy and the composition of the encrustations was checked by infra red analysis . Example 17

Tubes coated with polyvinyl alcohol as described in

Example 13 were used as urethral catheters in 6 minipigs and were indwelling for a period of 2 weeks . ucoεal inflam¬ matory changes were comparable to those reported in clinical studies in which accepted bio aterialε have been composed. None of these tubes showed macroscopic signs of encrustat¬ ion . E ample 18

Of 5 implantation studies reported in minipigs positive bacteriological cultures were present in 2 animals 2 months after implantatio .One of these animals had a poly- ur ethane εtent in situ, and the other had a εtent made of tubing as described in example 13. he combination of urinary infection and a εtent did not produce any increase in epith¬ elial changes.lt thus does not seen that PΞVA implanted in the urinary tract produces an increased likelihood of urin¬ ary infection .Urinary tract infection was not detected in the studies using rabbits. Conclusion

The experimental studies above, using tubes made of a graft copolymer according to the invention as indwelling ureteric and urethral prostheses suggest that PΞVA copolymerised using the invention compares favourably with the most biotolerant medical polymers for urological use.

Incidence of encrustation on rabbit urinary tract implants removed at one month (Example 16)

Animals Implants Urinary υK Analysis XΞS IR.

29 Silicone 8.0 Ca CaCO

38 7-5 Ca CaCO 42 7.0 Ca CaCO

4 ?VC 8.0 Ca CaCO

59 3,5 Ca CaCO 4-1 δ.o Ca CaCO

34 PVC 8.0 Ca CaCO

49 7.5 Ca CaCO 50 8.0 Ca CaCO

35 II y I on 7.5 ^• Ca CaCO 36 8.0 Ca CaCO 37 8.5 Ca, Kg CaCO

19 o..0 K

PΞVA 45 7-5 Ca, K CaCO Co olyaer 44 7.5 Al, Oa, CaCO