Management of encrusted ureteral stents: Two center experience

Abstract

Introduction: We present our experience of the endourological management of encrusted ureteral stents (EUS) and a literature review on forgotten encrusted ureteral stents. Methods: A total of 13 encrusted ureteral stents from 12 patients were removed in two hospitals. The medical records were retrospectively analyzed for stent indication, indwelling time, clinical presentation, investigations, type and the number of surgical procedures, operative time, complications, duration of hospital stay, and the follow-up. Results: Five ureteral stents (US) inserted before ESWL(extracorporeal shockwave lithotripsy) for renal stones, seven US for ureteric stones with ureteric colic, and one ureteral stent for post ureteroscopy procedure. The mean indwelling time was 15.07 ± 7.34 months with a range from 6 to 24 months. The mean Kidney,Ureter and Bladder (KUB) score of encrusta-tion grading was 11.84 ± 2.07 with a range from 9 to 15. The encrusted stents were removed by a combination of cystolithotripsy, semi-rigid ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy(PCNL), and ESWL. The average total number of procedures to remove one EUS was 3 ± 1.08 with a range of 2 to 5 proce-dures. Six encrusted stents were removed in one, five stents required two, one stent required three and one stent required four hospital admissions. The median operative time was 210 minutes with a range of 60 to 660 minutes per EUS removal and the mean hospital stay was 2.69 ± 1.43 days with a range of 1 to 6 days. All patients had successful removal of encrusted stent and complete stone clearance with no major complica-tions. In the follow-up, one patient had recurrent ureteric stone, one patient on regular stent exchange due to poor renal function and one patient developed significant ureteric stricture referred for reconstruction. Conclusions: Removal of forgotten encrusted impacted ureteral stents is challenging and requires a multimodal surgical approach. It adds significant costs to the health care system and in addition it affects patient safety and quality of life. Patient education, avoiding unnecessary ureteral stent place-ment and a computerized stent monitoring system reduces the incidence of forgotten ureteral stents and their complications.

Ureteral stent encrustation in an HIV patient treated with disposable flexible ureteroscope: a case report

“…An average of 3±1.08 operations per patient was reported by Thangavelu M et al . [ 7 ] for 13 cases. In our case, the first procedure was primarily to remove the calcification ureteral stent, and the second operation was to treat any remaining kidney stones.…”

“…Thangavelu M et al . [ 7 ] reported 13 management modalities for ureteral stent calcification: eight that involved bladder lithotripsy, ureteroscopy (URS), and retrograde intrarenal surgery (RIRS), two that involved URS and extracorporeal shock wave lithotripsy (ESWL), two that involved bladder stone, URS, RIRS, and ESWL. According to Torricelli FC's report [ 8 ], there was a considerably higher chance of bleeding in HIV patients who underwent percutaneous nephrolithotomy for upper urinary tract stones.…”

Tratamiento Endourológico de Catéter Calcificado en Injerto Renal: Presentación de Caso

“…10 Se puede considerar la NLPC en los casos que se considera una calcificación moderada o en casos en que la cirugía retrógrada intrarrenal (RIRS, por sus siglas en inglés) no es posible. 8 En este caso la ubicación de la neoureterocistostomia dificultó el acceso retrógrado para abordar el extremo proximal, por lo que se decidió un abordaje multimodal con NLPC y cistolitotripsia láser. Como aplicaron otros estudios similares, el abordaje con NLPC para el extremo proximal calcificado en el injerto renal es seguro, sin complicaciones intra operatorias, variando el diámetro de acceso desde 20 hasta 28 Fr, sin una disminución significativa en la función renal del injerto.…”

“…4,5 La presencia del CDJ por más tiempo del específico se conoce como catéter olvidado y puede provocar incrustaciones, calcificaciones intra luminales y extra luminales, fragmentación y obstrucción del ureter. 6,7,8 Se presenta el caso de retiro exitoso de un CDJ calcificado posterior a trasplante renal de donador vivo relacionado, mediante abordaje multimodal con técnicas endourológicas.…”

The influence of perioperative nursing intervention in patients with ureteral calculi treated with URSL and its correlation to adverse event incidence: A retrospective study

“…[ 12 , 13 ] However, patients often possess a limited understanding of URSL procedures, which can lead to misconceptions and engender negative emotions, thus adversely impacting surgical outcomes. [ 14 ] Consequently, the role of nursing interventions is crucial. They not only rectify misconceptions held by patients, but also enhance treatment adherence and foster postoperative recovery.…”