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

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.