Forgotten Double-J Ureteral Stent

Do ureteral stent diameter and length or patient demographics play a role in stent encrustation?

INTRODUCTION

Retained ureteral stents may constitute a technical challenge. The purpose of this study was to analyze the patient population with retained ureteral stents with regards to stent sizes to better understand if these factors could play a pivotal role in their encrustation.

METHODS

After institutional review board approval, we retrospectively analyzed the data of patients who underwent multimodal surgical procedures for the removal of retained ureteral stents from 2010-2018. The primary outcomes analyzed were ureteral stent length and diameter, location of stent placement, and patients' demographics as potential etiologies for encrustation.

RESULTS

We included 30 patients with 32 encrusted ureteral stents and 37 patients with 46 forgotten non-retained ureteral stents. Indications for stenting included urolithiasis, malignancy, pregnancy, ureteral stricture, and ureteropelvic junction obstruction. Stent diameters ranged from 6-8.5 Fr. Stent lengths ranged from 22-30 cm, and multilength stents were used too. Smaller diameter stents were less likely to be retained when compared to larger diameter stents (>6 Fr) (p=0.002). Overall stent length was not found to be significant (p=0.251); however, the difference in stent surface area differed by over 1 cm (p<0.001). Patients who were uninsured were more likely to have retained stents (p=0.003). Patients who reside with longer commuting distance to the main academic medical center were more likely to have retained stents (p=0.010).

CONCLUSIONS

Retained ureteral stents could be avoided. Taking into consideration ureteral anatomical variation among patients, smaller diameter stents and smaller surface area may prevent encrustation. Uninsured patients with farther distance to seek medical care and females are the most at risk.

Ureteral stent complications - experience on 50,000 procedures

Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed to evaluate an important number of procedures, the complications of ureteral stents, and their prevention and treatment retrospectively. We evaluate 50,000 procedures performed between 1996 and 2021 on 36,688 patients. According to the stenting duration, the cases were divided into short-term (less than 6 weeks – 34,213 procedures), respectively long-term stenting (more than 6 weeks – 15,757 procedures). The indications of stenting for both groups were noted. The total number of complications was 41,369. We encountered 153 cases (0.3%) of JJ stent malposition, of which 3 cases were into the retroperitoneum, one case with parenchymal perforation and hematoma. Considering the double J migrations, we found proximal migration in 427 cases (0.9%) and distal double J migrations in 352 (0.7%) cases. The obstruction of the ureteral stent, causing inefficient drainage, was encountered in 925 cases, while irritative bladder symptoms occurred in 16,326 cases (32.7%). Hematuria was observed in 5,213 cases, in 7 cases blood transfusion being necessary. Urinary tract infection was diagnosed in 7,436 cases (14.8%). Stent encrustation and calcification occurred in 832 cases, while stent fragmentation was noted in 52 cases. Double J stent complications should be promptly evaluated and treated. Encrustation and stone formation in forgotten stents often lead to serious complications and should be managed with stent removal and combined endourological techniques.