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Abstract
ABSTRACTObjective: To evaluate the role of extracorporeal shockwave lithotripsy (ESWL) for the management of ‘forgotten’ encrusted stents.Patients and Method: This is a retrospective study of 133 patients with forgotten JJ stents, treated between January 2015 and January 2018. Encrustation was mainly found in the renal coil of the stent with distal concomitant encrustation in the vesical and/or ureteric segment. After laboratory and radiological assessment, treatment started with ESWL for the renal encrustation before successful extraction. Auxiliary endourological procedures were used for the encrusted vesical or ureteric segments. Failed cases underwent open surgery.Results: The mean (SD; range) JJ stent indwelling time was 25.84 (10; 14–70) months. In all, 96 (72.2%) patients were seen after treatment for stone disease. In total, 94 patients (70.7%) were managed by ESWL monotherapy, whilst in 36 (27%) additional endourological procedures were required before successful extraction including: cystolithotripsy 19 patients (52.8%), ureteroscopic lithotripsy eight (22.2%), and percutaneous nephrolithotomy nine (25%). Open surgery was required in only three patients (2.3%). A mean of 0.28 procedures per patient was required before smooth stent extraction. The encrusted stents were removed after the first, second, third, and fourth ESWL sessions in 44 patients (33.1%), 43 (32.3%), 26 (19.5%), and 17 (12.8%), respectively. Patients with forgotten indwelling JJ stents for >2 years had significantly larger and harder encrustation at both JJ coils.Conclusion: ESWL proved a feasible first-line treatment for forgotten encrusted JJ stents. The indwelling time of forgotten stents in the urinary tract is associated with greater encrustation burden, density and multiple sites of encrustation.Abbreviations: CLT: cystolithotripsy; ESWL: extracorporeal shockwave lithotripsy; HU: Hounsfield unit; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; PCNL: percutaneous nephrolithotomy; URL: ureteroscopic lithotripsy
Highlights
Stenting the ureter with a JJ stent is an essential part of many urological procedures, whether needed following open or endoscopic ureteric surgery [1]
If the stent is forgotten for a long time, possible complications may occur such as urinary tract infection (UTI), stone formation, fragmentation, migration; or encrustation and more seriously secondary renal dysfunction
The preoperative site and burden of encrustation evaluated by KUB and non-enhanced spiral CT was important to decide the treatment plane after initial extracorporeal shockwave lithotripsy (ESWL)
Summary
Stenting the ureter with a JJ stent is an essential part of many urological procedures, whether needed following open or endoscopic ureteric surgery [1]. Sometimes it can be placed preoperatively to avoid iatrogenic intraoperative ureteric injury during major pelvic operations for gynaecological and colorectal surgery. It has been used as a lifesaving procedure in cases with calcular anuria and ureteric obstruction with infection. Patients with ureteric obstruction from an encrusted forgotten stent can present with life-threatening urosepsis, which may be lethal in some cases [2,3,4]. The biochemical and optical analysis of stent encrustation has shown that encrustations consist mainly of calcium oxalate, calcium phosphate, and ammonium magnesium phosphate [6,7]
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