Morphology of mineral deposits on encrusted urinary catheters investigated by scanning electron microscopy.

Struvite and hydroxyapatite were precipitated from artificial urine onto the surfaces of catheter materials by the controlled addition of urease. They were precipitated both together and separately (by omitting components of the artificial urine), and with and without the inclusion of albumin (which was intended to mimic the proteinaceous debris found in infected urine). Precipitates were identified by X-ray powder diffraction and the artificially encrusted surfaces examined by scanning electron microscopy. In the presence of protein, hydroxyapatite was precipitated as a poorly crystalline form which aggregated to form a crust. Struvite crystals could be easily identified under the scanning electron microscope by their relatively large size and characteristic appearance. Fifteen encrusted catheters from patients were also examined by scanning electron microscopy, and a further six using X-ray microanalysis. Their appearance was very similar to that of the materials encrusted in vitro. Encrustation involves the formation of hydroxyapatite and the growth of struvite crystals, intimately associated with bacteria.