Endourologic Management of Forgotten Encrusted Ureteral Stents: Can Ureteroscopic Lithotripsy be Avoided?

Abstract

We present endourologic management strategies and tricks to minimize instrumentation and complications in long-indwelling encrusted stents. Seventeen patients presented with 19 retained ureteral stents (median indwelling time 3.0 y; 0.25 to 17 y). Investigations included x-ray, ultrasound, noncontrast computed tomography, excretory urography, magnetic resonance imaging, Tc diethylenetriaminepenta-acetic acid scan, and retrograde ureterography. Incrustation was present in all stents, encrustation 16, stone formation 11, and spontaneous fragmentation 3. All patients had gaping of ureteric orifices and dilated capacious ureters with no stent impaction. Management included extracorporeal shock wave lithotripsy (2), simple pull under fluoroscopy cystoscopically (2) and ureteroscopically (2), cystolithotripsy (10), percutaneous nephrolithotripsy (6), nephrectomy (2), and no intervention (2). In 3 patients with large encrustation burden, tubular encrustation in ureteral segment of stent could be removed intact without lithotripsy. To conclude, encrusted ureteral stents can be successfully managed using endourologic interventions. Owing to capacious ureter and nonimpacted stent, a careful attempt of pulling can be made under fluoroscopic guidance to minimize the time of ureteroscopic lithotripsy and complications thereof.