Ureteral
stents are widely used in many urologic practices. However,
stents can cause significant complications including migration, fragmentation, and encrustation and it may possibly be forgotten. Successful management of a retained, encrusted
stent requires combined endourological approaches.
OBJECTIVES: Seventy four patients with forgotten ureteral
stents were managed by different open (nephrolithotomy and/or cystolithotomy), or endoscopic procedures in our center. Among these, 11 patients had severe encrustation (stones larger than 35 mm within the bladder or kidney) and seven patients of this group, presented at our department between July 2007 and December 2010. Combined endourological procedures percutaneous nephrolithotripsy (PCNL), cystolithotripsy (CLT), transurethral
lithotripsy (TUL) were performed in one or 2 separate sessions. In these 7 patients the whole of the
stents, especially both ends were encrusted. Initially, cystolithotripsy, retrograde ureteroscopy and TUL were performed in the dorsal lithotomy position. Following this, a gentle attempt was made to retrieve the
stent with the help of an ureteroscopic grasper. In some cases the
stent was grasped by a hemostat clamp out of the urethral meatus with a gentle
traction to facilitate
lithotripsy in the ureter and even in the kidney. Finally, a ureteric
catheter was placed adjacent to the
stent for injection of radio-
contrast material to delineate the renal pelvis and the calyces. Then in the same session or later in another session the patient was placed in the prone position and PCNL of the upper coil of the encrusted
stent along with
calculus was done and the
stent was removed.
RESULTS: In 5 out of seven patients, the initial indication for
stent placement was for
urinary stone disease after open nephrolithotomy and pyeloplasty in other centers and in two patients after TUL. All patients underwent the procedure (s) under
spinal anesthesia and all received
antibiotics in
preoperative period. The only available source of energy in our center was pneumatic
lithotripsy.
CONCLUSIONS: Multiple endourological approaches or even open surgery are needed because of encrustations and the associated stone burden that may involve bladder, ureter and kidney. This may require single or multiple endourological sessions or rarely open surgical removal of the encrusted
stents. Although, endourological management of these
stents achieves success in majority of the cases with minimal complications, the best treatment that remains is prevention of this complication and to achieve this important point designing a recall system is suggested.