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

Abstract

Purpose: To describe our experience in the management of retained encrusted ureteral stents using a single session combined endourological approach. Materials and Methods: Patients with retained encrusted ureteral stents who had been submitted to a single session combined endourological approach from June 2010 to June 2018 were prospectively evaluated. Patients were divided according to the Forgotten-Encrusted-Calcified (FECal) classification. The stone burden, surgical intervention, number of interventions until stone free status, operation time, hospital stay, complications, stone analysis, and stone-free rate were compared between groups. ANOVA was used to compare numerical variables, and the Mann-Whitney or Chi-square test to compare categorical variables between groups. Results: We evaluated 50 patients with a mean follow-up of 2.9±1.4 years (mean±SD). The groups were comparable in terms of age, sex, laterality, BMI, comorbidities, ASA, reason for stent passage, and indwelling time. The stone burden was higher for grades IV and V (p=0.027). Percutaneous nephrolithotomy was the most common procedure (p=0.004) for grades IV and V. The number of procedures until the patients were stonefree was 1.92±1.40, and the hospital stay (4.2±2.5 days), complications (22%), and stone analysis (66% calcium oxalate) were similar between groups. The stone-free rate was lower in grades III to V (60%, 54.5%, and 50%). Conclusions: The endoscopic combined approach in the supine position is a safe and feasible technique that allows removal of retained and encrusted stents in a single procedure. The FECal classification seems to be useful for surgical planning.

Combined endoscopic approaches in management of complicated forgotten double J stent: A case report

“…With the advent of Supine PCNL and flexible ureterosopy, combined approach can be used without the repositioning of the patient in the same setting for the management of he retained DJ stent with encrustation. 10 A stepwise approach should be used to manage forgotten DJ stents with complications, and combined endourological procedures are almost always successful in managing these challenging cases.…”

Will the advances in retrograde intrarenal surgery extinguish percutaneous nephrolithotomy for stones larger than 2 cm?

“…Also, “forgotten stent” can develop into severe encrustation ( 26 ) and its removal may require refined management planning and advanced surgical techniques ( 27 , 28 ). Strategies to prevent such problem include stent judicious use and the implementation of modern technology to keep track of stented patients ( 29 , 30 ).…”

One week pre-operative oral antibiotics for percutaneous nephrolithotomy reduce risk of infection: a systematic review and meta-analysis

“…Percutaneous nephrolithotomy (PCNL) is the current gold standard treatment for kidney stones > 20 mm (1). Although effective, PCNL is associated with complications such as prolonged urinary leakage in up to 10% and blood transfusion in up to 7% of the patients (2)(3)(4)(5). Approximately 10% of the patients develop a postoperative fever after PCNL, while sepsis is reported in 0.3% to 0.5% (5,6).…”