Management of ‘forgotten’ encrusted JJ stents using extracorporeal shockwave lithotripsy: A single-centre experience

Abstract

Objective: To evaluate the role of extracorporeal shockwave lithotripsy (ESWL) for the management of 'forgotten' encrusted stents. Patients and Method: This is a retrospective study of 133 patients with forgotten JJ stents, treated between January 2015 and January 2018. Encrustation was mainly found in the renal coil of the stent with distal concomitant encrustation in the vesical and/or ureteric segment. After laboratory and radiological assessment, treatment started with ESWL for the renal encrustation before successful extraction. Auxiliary endourological procedures were used for the encrusted vesical or ureteric segments. Failed cases underwent open surgery. Results: The mean (SD; range) JJ stent indwelling time was 25.84 (10; 14-70) months. In all, 96 (72.2%) patients were seen after treatment for stone disease. In total, 94 patients (70.7%) were managed by ESWL monotherapy, whilst in 36 (27%) additional endourological procedures were required before successful extraction including: cystolithotripsy 19 patients (52.8%), ureteroscopic lithotripsy eight (22.2%), and percutaneous nephrolithotomy nine (25%). Open surgery was required in only three patients (2.3%). A mean of 0.28 procedures per patient was required before smooth stent extraction. The encrusted stents were removed after the first, second, third, and fourth ESWL sessions in 44 patients (33.1%), 43 (32.3%), 26 (19.5%), and 17 (12.8%), respectively. Patients with forgotten indwelling JJ stents for >2 years had significantly larger and harder encrustation at both JJ coils. Conclusion: ESWL proved a feasible first-line treatment for forgotten encrusted JJ stents. The indwelling time of forgotten stents in the urinary tract is associated with greater encrustation burden, density and multiple sites of encrustation.

Patients with encrusted ureteral stents can be treated by a single session combined endourological approach

“…Ulker et al ( 17) treated 17 patients with a 58.9% stone-free rate in a single procedure, however, they were evaluated with KUB. Given that treat- ment is generally difficult, with potential hazardous complications (18,20,21), we believe that these cases should be referred to high volume endourological centers with experienced staff. Compared to other grading systems for encrusted stents, the FECal classification system developed by Acosta-Miranda et al incorporate both stone location and size (3).…”

A Forgotten Ureteral Stent: Potential Risks for the Urinary Function

“…Multiple sessions may be required. Previous studies have indicated a relatively high success [7-9]. Existing literature also shows that endourological treatment is feasible even in complex cases [10].…”

Forgotten Double-J ureteral stent: An analysis of 25 cases in a tertiary hospital

“…The management of forgotten JJ stent constitutes a dilemma to the urologist and sometimes may be difficult, complicated, risky and expensive. Although open surgery has been reported as a treatment modality, other minimally invasive procedures are followed; of these techniques, extracorporeal shockwave lithotripsy (ESWL), or internal lithotripsy with percutaneous nephrolithotomy (PCNL), cystolithotripsy (CLT), ureteroscopic lithotripsy (URL) have all been used either alone or in combination to tackle this problem [ 5 ].…”