Endourological Management of Forgotten Encrusted Ureteral Stents

Abstract

Purpose: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. Materials and Methods: From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. Results: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. Conclusion: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

Forgotten Reminders: an Experience with Managing 28 Forgotten Double-J Stents and Management of Related Complications

“…Patient and sometimes physician compliance issues lead to stents being forgotten [14]. Poor compliance of the patients represents the main cause [15], which is reflected in our study as well. Proper information and education of the patient regarding the need for stent removal or change is necessary.…”

“…A renal scan may be done to document the function. Murthy et al found Bno additional benefit with the use of NCCT^ [15]. In our opinion, NCCT should be done in all the cases where indwelling time is more than 1 year as the stone burden may be radiolucent on plain X-ray.…”

“…Single procedure removal of encrusted stent has also been reported [15,20], but it should be avoided for severely encrusted stents where long intraoperative times are expected, large stone burden, and for patients with multiple comorbidities. In case of long intraoperative time, over enthusiastic single-stage removal is discouraged, and it is better to stage the procedure.…”

Use of cystourethroscopy to remove an indwelling double-J ureteral stent 6 years following simultaneous radical sigmoid colon cancer and partial bladder resection: A case report

“…Recently, multiple endourological approaches and open surgery have been developed to remove the stents in patients with stent-related complications. An endourological procedure is widely accepted for removing ureteral stents, which is more efficient with less wound complications and shorter recovery times than open surgery (6,7). The present study reports a rare case of a patient with a coiled D-J stent which was not removed for 6 years, which resulted in the development of encrustation and was extracted successfully by cystourethroscopy with holmium laser lithotripsy.…”

Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

“…[12][13][14][15][16][17][18][19][20] Although there are no formal guidelines in the management of encrusted double-J stents, 15 several authors have reported their series and proposed algorithms: some with multiple sequential surgical techniques; 15,[19][20][21][22][23] others with a one-step approach. 18,24 Even in this single approach technique, after cystolithopaxy or URS in lithotomy position, the patient must be turned prone for PCNL.…”