MP68-05 SINGLE SURGEON EXPERIENCE WITH RETAINED ENCRUSTED STENTS: COMBINED ENDOUROLOGICAL APPROACH AND MODIFIED GRADING SYSTEM

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VI1 Apr 2017MP68-05 SINGLE SURGEON EXPERIENCE WITH RETAINED ENCRUSTED STENTS: COMBINED ENDOUROLOGICAL APPROACH AND MODIFIED GRADING SYSTEM Roberto Lopes, Carlos Watanabe-Silva, Fabricio Beltrame, Alexandre Danilovic, Joaquim Claro, and Fabio Vicentini Roberto LopesRoberto Lopes More articles by this author , Carlos Watanabe-SilvaCarlos Watanabe-Silva More articles by this author , Fabricio BeltrameFabricio Beltrame More articles by this author , Alexandre DanilovicAlexandre Danilovic More articles by this author , Joaquim ClaroJoaquim Claro More articles by this author , and Fabio VicentiniFabio Vicentini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2321AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The encrusted and retained ureteral stent represents the most challenging complication associated with ureteral stents. The aim of our study is to describe our experience in the management of retained encrusted stents using a combined endourological approach and also to suggest a modified grading system for stent encrustation. METHODS All of the procedures were carried out by the same first surgeon, who is experienced in prone and supine PCNL, retrograde ureteroscopy and retrograde intrarenal surgery. Surgical management was based on the location and the stone burden of cases (considering encrusted stents and associated stones) and of course renal function. Between June 2010 and June 2015, all patients referred with retained and encrusted ureteral stents to our hospital were submitted to a combined endourological approach with a Galdakao-modified Valdivia positioning supine removal of the stents without need of bolster below the patient. RESULTS Fifty patients were evaluated. Two groups were created additionaly to the grading system proposed by Acosta-Miranda et al: calcified and broken stent (stage VI - 9 cases) and isolated ureteral calcification (stage VII - 5 cases). Percutaneous nephrolithotripsy was common for stages III to VI and rare or not performed in stage I, II and VII, as these encrustations were usually minor and not located in the kidney and therefore did not hinder stent extraction (p=0.004). Ureterolithotripsy was commonly used for ureteral stent encrustation, especially in groups with lower stone burden (stages I and II) and stage VII (ureteral only). Length of operation was higher for groups with severe stone burden (stages III and IV - 158.1±64.8 min) when compared to moderate stone burden (stage III - 110.0±64min) and low stone burden (stages I, II, VI and VII - 78.6±29.8 min) - p value 0,0012. Number of procedures, length of stay, blood transfusion, complications and stone analysis were similar between groups. Stone-free was worse in stages III to V, as expected, due to higher stone burden, even though not statistically significant. All stents were successfully removed in all cases (100%) by our combined endourological approach, which was the primary objective of our study. CONCLUSIONS Galdakao-modified Valdivia positioning supine removal of retained and encrusted stents is a safe and feasible technique, with all catheters removed in a single procedure. A modified classification of the encrusted stones might help urologists to advise their patients on expected surgical outcomes. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e919-e920 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Roberto Lopes More articles by this author Carlos Watanabe-Silva More articles by this author Fabricio Beltrame More articles by this author Alexandre Danilovic More articles by this author Joaquim Claro More articles by this author Fabio Vicentini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...