Experience of retaining encrusted ureteral stents: URL by 4.5/6.5F ureteroscope can reduce the possibility of PCNL

Endoscopic management of encrusted ureteral stents: outcomes and tips and tricks

PURPOSE

To report our experience in the management of encrusted ureteral stents (EUS) and provide technical insight of our endourological approaches for difficult scenarios posed by this entity.

MATERIALS AND METHODS

A retrospective evaluation of a longitudinally collected database of 58 patients with encrusted US between December 2012 and May 2022 was performed. The ureteral stents were initially inserted due to obstructive uropathy, pyelonephritis or after a successful endoscopic procedure for urolithiasis. A combination of antegrade/retrograde treatment in single or multiple sessions took place for the retrieval of the encrusted stents. Non-contrast enhanced computer tomography was used for the follow-up of the patients at 1-month after the removal of the encrusted stent.

RESULTS

Overall 58 patients, 39 males and 19 females with a median age of 51 years old were included in the study. Indwelling time was < 6 months, 6-12 months and > 12 months in 22%, 57% and 21% of the cases, respectively. All US were successfully removed. Semi-rigid ureteroscopy (URS) and flexible ureteroscopy (fURS) were used in 90% of the cases. In 10% of the cases, a second-stage percutaneous nephrolithotomy (PCNL) or endoscopic combined intrarenal surgery (ECIRS) was performed. All US were successfully released. Stone-free rate was 84% at 1-month. Overall complication rate was 10.5% (mostly postoperative fevers, 5.4%).

CONCLUSION

Removal of the encrusted US is a challenging procedure. Appropriate decision-making and knowledge of specific tricks may result in safe and successful management of significant EUS.

Outcomes Associated with the Endourological Management of Stent Encrustation: Findings from a Literature Review on Behalf of the EAU YAU Urolithiasis Group

PURPOSE OF REVIEW

Double J ureteric stents (DJs) are useful aids for urinary drainage in case of stones or tumour causing ureteric obstruction. Prolonged dwelling time such as when forgotten can lead to encrustation. Our aim was to perform a literature review to evaluate outcomes associated with endourological management of encrusted stents (ES).

RECENT FINDINGS

There now exist validated tools which can aid in grading the severity of encrustation and aid operative planning such as the total number of surgeries that may be required. Evaluation of different treatment strategies remains under reported. Removal of encrusted stent is a challenging problem, and it typically requires a multimodal endourological approach.

The “Tri-Glide” Technique: A Case Report on a Novel Intraoperative Approach for Removal of Retained and Encrusted Ureteral Stents

Background

Retained ureteral stents can result in significant morbidity and can be surgically challenging to urologists. A multimodal approach is often necessary for removal, potentially including retrograde and antegrade procedures performed over multiple anesthetic sessions. We describe the novel “Tri-Glide” technique for treating retained stents, particularly those with stent shaft encrustation prohibiting safe removal. Case Presentation. Two patients with nephrolithiasis and retained, encrusted ureteral stents were managed with the “Tri-Glide” technique. Patient #1 was a 58-year-old man with a severely calcified ureteral stent, retained for 14 years. After undergoing simultaneous cystolitholapaxy and percutaneous nephrolithotomy to treat proximal and distal encrustations, the stent shaft remained trapped in the ureter due to heavy calcifications. Three hydrophilic guidewires were passed alongside the stent, allowing it to easily slide out of the ureter intact. Patient #2 was a 74-year-old man who after only 3-months of stent dwell time developed severe stent shaft encrustation preventing removal. After multiple maneuvers failed, the “Tri-Glide” technique was used to create a smooth track for stent to slide out intact with gentle traction. Both patients did well postoperatively with no complications.

Conclusion

The “Tri-Glide” technique can aid in the management of complex encrusted stent extractions, especially when there is significant shaft encrustation.

Removal of an encrusted ureteral stent by cutting the stent with a holmium laser using 4.5-Fr semi-rigid and flexible ureteroscopes

INTRODUCTION

Ureteral stents (double-J stents) are widely used in urology to prevent or relieve ureteral obstruction and have become an integral part of urological practice. We have often experienced cases in which a stent cannot be removed due to encrustation.

CASE PRESENTATION

We describe the case of a 54-year-old male, who presented with a severely encrusted ureteral stent, which had only been inserted for one month until second surgery for renal stones. The ureteral stent could not be removed as it had become encrusted with renal stones. The encrusted ureteral stent was successfully removed by cutting it with a Ho:YAG laser using 4.5/6.5-Fr semi-rigid and flexible ureteroscopes retrogradely. The patient subsequently remained stone-free without any complication.

CONCLUSION

We experienced a case in which an encrusted ureteral stent was successfully removed retrogradely. Technological advancements in endourology will hopefully make the treatment of such cases safer and less invasive.

WITHDRAWN: Analysis on the diagnosis of infection risk factors and the incidence of ureteroscopy holmium laser lithotripsy and vagal excitation under computed tomography image information health technology

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