Percutaneous Nephrostolithotomy Research Articles

A PROSPECTIVE RANDOMIZED COMPARISON OF TYPE OF NEPHROSTOMY DRAINAGE FOLLOWING PERCUTANEOUS NEPHROSTOLITHOTOMY: LARGE BORE VERSUS SMALL BORE VERSUS TUBELESS

We compared postoperative outcomes among tubeless, conventional large bore nephrostomy drainage and small bore nephrostomy drainage following percutaneous nephrostolithotomy (PCNL) in a prospective randomized fashion. Between January and June 2001, 30 patients undergoing PCNL were randomized to receive conventional large bore (20Fr) nephrostomy drainage (group 1, 10 patients), small bore (9Fr) nephrostomy drainage (group 2, 10 patients) or no nephrostomy drainage (group 3, 10 patients). Inclusion criteria included a single subcostal tract, uncomplicated procedure, normal preoperative renal function and complete stone clearance. Factors compared among the 3 groups were postoperative analgesia requirement, urinary extravasation, duration of hematuria, duration of urinary leak, decrease in hematocrit and hospital stay. The postoperative analgesic requirement was significantly higher in group 1 (217 mg) compared to groups 2 (140 mg, p <0.05) and 3 (87.5 mg, p <0.0001). Patients in group 3 had a significantly shorter duration (4.8 hours) of urinary leak through the percutaneous renal tract compared to patients in groups 1 (21.4 hours, p <0.05) and 2 (13.2 hours, p <0.05). Hospital stay was significantly shorter in group 3 (3.4 days) compared to groups 1 (4.4 days, p <0.05) and 2 (4.3 days, p <0.05). All 3 groups were similar in terms of operative time, duration of hematuria and decrease in hematocrit. Postoperative ultrasound did not reveal significant urinary extravasation in any case. Tubeless PCNL is associated with the least postoperative pain, urinary leakage and hospital stay. Small bore nephrostomy drainage may be a reasonable option in patients in whom the incidence of stent dysuria is likely to be higher.

Developing renal tract for minimally invasive percutaneous nephrostolithotomy before operation under the guidance of xanthippe and B-uitrasound

目的 探讨术前X线摄片和B超定位引导建立经皮肾穿刺通道,行微创经皮肾输尿管镜取石术(MPCNL)治疗肾结石和输尿管上段结石的手术方法和临床价值.方法术前将病人模拟手术体位,作X线下结石摄片定位与B超下肾穿刺点、穿刺方向及深度定位,建立经皮肾穿刺通道,对158例肾结石、输尿管上段结石病人行微创经皮肾穿刺输尿管镜取石术治疗.结果 158例结石病人中153例手术成功,5例失败,无一例中转开放性手术.120例肾结石总取净率88.33%,肾盂梗阻解除率100%.49例输尿管上段结石(包括合并肾结石11例)均一次取净结石,总取净率100%.结论术前B超和X线摄片定位引导建立经皮肾穿刺通道行微创经皮肾输尿管镜取石术可减少病人和术者的射线接受量,技术可行。

1899: Percutaneous Nephrostolithotomy: Impact of Access Point Number and Location on Complications

You have accessJournal of UrologyDiscussed Poster, Wednesday, May 12, 2004, 8:00am- 12:00 pm1 Apr 20041899: Percutaneous Nephrostolithotomy: Impact of Access Point Number and Location on Complications Brian R. Matlaga, Steve J. Hodges, Ojas Shah, and Dean G. Assimos Brian R. MatlagaBrian R. Matlaga More articles by this author , Steve J. HodgesSteve J. Hodges More articles by this author , Ojas ShahOjas Shah More articles by this author , and Dean G. AssimosDean G. Assimos More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)39091-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1899: Percutaneous Nephrostolithotomy: Impact of Access Point Number and Location on Complications." The Journal of Urology, 171(4S), p. 502 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 502 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Brian R. Matlaga More articles by this author Steve J. Hodges More articles by this author Ojas Shah More articles by this author Dean G. Assimos More articles by this author Expand All Advertisement Loading ...

1677: A Comparison of a Novel one Step Percutaneous Nephrostolithotomy Sheath with the Standard Two Step Device

1677: A Comparison of a Novel one Step Percutaneous Nephrostolithotomy Sheath with the Standard Two Step Device

A New Technique for Treating Forgotten Indwelling Ureteral Stents: Silk Loop Assisted Ureterorenoscopic Lithotripsy

Treating forgotten indwelling ureteral stents is difficult because forgotten stents become encrusted and fragmented. Therefore, we developed a silk loop with which to loop the lower end of a forgotten ureteral stent during ureterorenoscopy to supply a counterforce, which fixed the stent while separating encrusted stones from the forgotten stent. We evaluated the success of the silk loop method. Nine patients were enrolled in this study from 1997 to 2003. Each patient had a forgotten ureteral stent with renal stones on the tip of the proximal end. All consented to the procedure of silk loop assisted ureterorenoscopic lithotripsy (URSL) with a Lithoclast (Microvasive, Natick, Massachusetts) lithotriptor. We successfully removed the forgotten indwelling stent from all 9 patients with the silk loop assisted URSL method. Silk loop assisted URSL makes the removal of forgotten stents easier. While percutaneous nephrostolithotomy and open surgery produce successful results, the silk loop method is less invasive and expensive, and it minimizes hospital recovery time.

Sensitivity of chest fluoroscopy compared with chest CT and chest radiography for diagnosing hydropneumothorax in association with percutaneous nephrostolithotomy

Objectives Hydropneumothorax (HPTX) is recognized as a potential complication of percutaneous nephrostolithotomy (PCNL), particularly with supracostal access. Postoperative chest radiography (CXR) is routinely used to evaluate the chest after PCNL. We prospectively compared the sensitivity of intraoperative chest fluoroscopy with immediate postoperative portable CXR and postoperative day 1 chest computed tomography (CT) for the detection of pleural fluid. Methods A total of 89 consecutive patients (mean age 47.9 ± 13.3 years; 100 renal units) undergoing PCNL were prospectively evaluated with intraoperative fluoroscopy at the conclusion of the procedure and then with anteroposterior CXR in the postanesthesia care unit and postoperative day 1 noncontrast, thin-cut CT of the kidneys and lung bases. CT imaging of the lung bases comprised the reference standard for detecting pleural fluid. Results A total of 104 percutaneous renal accesses in 100 renal units, 60 above and 44 below the 12th rib, were used. In 16 cases (16%), a second-stage procedure was performed to clear residual stone fragments detected on post-PCNL CT. HPTX was detected in 1, 8, and 38 cases by initial fluoroscopy, immediate postoperative CXR, and CT scan, respectively. Intervention was necessary in 7 patients. In 2 patients with fluoroscopic evidence of pleural fluid (1 at the initial PCNL and 1 during second-look flexible nephroscopy), intraoperative pleural drainage was performed percutaneously. In the other 5 patients, intervention was determined by the size of the HPTX on chest CT scan (n = 1) or the presence of symptoms (n = 4). In no case was intervention performed on the basis of the immediate postoperative CXR findings when intraoperative chest fluoroscopy was negative. Conclusions Intraoperative chest fluoroscopy during PCNL is sufficient to detect clinically significant HPTXs, and, therefore, routine postoperative CXRs are not necessary. However, a high index of suspicion based on clinical symptoms postoperatively should prompt chest imaging.

Computerized Tomography Guided Access for Percutaneous Nephrostolithotomy

Access for percutaneous nephrostolithotomy (PNL) using conventional fluoroscopic guidance may carry an increased risk of damage to surrounding organs in patients with renal calculi and aberrant anatomy. In these situations cross-sectional anatomical imaging may facilitate safe percutaneous access. We describe our experience with computerized tomography (CT) guided percutaneous access for such patients undergoing PNL. Between June 2000 and December 2001, 154 patients underwent PNL at our institution. Five of these patients (3%) required a total of 6 percutaneous access tracks under CT guidance. All patients in this group had anatomical abnormalities precluding standard access to the collecting system without risk to adjacent organs. These abnormalities included a retrorenal colon in 2 and a severely distorted body habitus due to spinal dysraphism in 3. Percutaneous access was achieved without complication in all cases. At subsequent PNL 5 of the 6 renal units (83%) were rendered completely stone-free. CT guided percutaneous access is infrequently required for PNL. However, there is a select group of patients with anatomical anomalies that may predictably require this procedure to facilitate safe and efficacious PNL.

Ureteroscopically assisted percutaneousrenal access

Percutaneous nephrostolithotomy is a common procedure for removing kidney stones. Obtaining percutaneous access can be difficult in some patients. We describe our technique of ureteroscopically assisted percutaneous renal access for patients in whom standard percutaneous access may be challenging.

Pediatric Staghorn Calculi: The Role of Extracorporeal Shock Wave Lithotripsy Monotherapy With Special Reference to Ureteral Stenting

Pediatric Staghorn Calculi: The Role of Extracorporeal Shock Wave Lithotripsy Monotherapy With Special Reference to Ureteral Stenting

Oops we got in the chest: fluoroscopic chest tube insertion for hydrothorax after percutaneous nephrostolithotomy

Percutaneous supracostal renal puncture provides ideal access to the collecting system or proximal ureter but is associated with an increased risk of pleural injury. We describe a simplified approach to intraoperative thoracostomy tube placement that uses urologic techniques and protects against recurrent hydrothoraces at second-look nephroscopy, without increasing patient morbidity or length of hospital stay.

Ureteroscopic treatment of renal calculi in morbidly obese patients: a stone-matched comparison

Objectives. To report a matched comparison of morbidly obese (MO) patients and normal weight (NW) patients who underwent ureteroscopic (URS) treatment of renal calculi. Shock wave lithotripsy and percutaneous nephrostolithotomy may be precluded in MO patients, and URS treatment offers a minimally invasive alternative. Methods. We retrospectively reviewed the charts of patients who underwent URS at our institution between 1997 and 2000. Fifty-four patients underwent URS treatment solely for renal calculi. Sixteen MO patients underwent 18 procedures. Thirty-eight NW patients, who underwent 39 procedures, were matched to the MO patients by stone location and size. Stones were categorized by location and size, less than 10 mm or 10 mm or greater. The factors and outcomes assessed were stone length, operative time, presence of a ureteral stent, success, and complications. Results. The overall success rate was 83% (15 of 18 procedures) for MO patients and 67% (26 of 39 procedures) for NW patients, but this difference was not significant ( P = 0.23). The difference in the success rate for renal calculi 10 mm or greater (100% versus 38%) approached significance ( P = 0.09). This may be related to other distinctions between the groups. URS treatment was often a salvage therapy in the NW group after other modalities failed. No significant differences were found between the other outcomes. Conclusions. URS treatment of renal calculi when matched for location and size is as successful and no more morbid in MO than in NW patients. URS treatment of renal calculi is a safe and effective first-line treatment for renal calculi in MO patients.

Nonvascular interventions of the urinary tract.

Nonvascular intervention of the urinary tract is a well-established uroradiologic subspecialty, which is more important for avoiding invasive open surgery in the age of rising demand about the value of less invasive treatment. Various kinds of nonvascular intervention are recently performed under image-guidance and are as follows: percutaneous nephrostomy, percutaneous nephrostolithotomy, percutaneous dilatation of the urinary tract, sclerotherapy for renal cysts, percutaneous catheter drainage, percutaneous foreign body retrieval and biopsy. Percutaneous nephrostomy is a basic technique to provide a direct access to urinary tract, which makes it possible to perform other interventional procedures. Although nonvascular intervention may produce some complications, it is generally considered to be less invasive than open surgery and has advantages such as short hospital stay, early return to normal life and therefore economic savings. This review is described to help clinicians easily understand the procedures, indications, techniques, and complications with figures of cases the authors experienced.

INFUNDIBULAR STENOSIS AFTER PERCUTANEOUS NEPHROLITHOTOMY

Acquired infundibular stenosis can develop after percutaneous nephrolithotomy. We review our experience with infundibular stenosis after this procedure. We evaluated the records of patients diagnosed with infundibular stenosis after percutaneous nephrolithotomy was performed at our institution between 1995 and 2000. Analysis included medical history, urinary stone type, stone removal procedure technique, length and number, postoperative course, stenosis time to development location, severity and treatment, and treatment outcome. Infundibular stenosis developed in 5 of 223 percutaneous nephrolithotomy cases (2%) performed during this period. Medical history in affected patients included previous ipsilateral open pyelolithotomy, diabetes and morbid obesity in 2 each. Percutaneous nephrolithotomy were done through a standard 30Fr nephrostomy tract and all cases were terminated before complete stone removal. Mean operative time was 258 minutes, which was significantly greater than the mean operative time of 207 minutes in all cases of unilateral percutaneous nephrolithotomy (p = 0.03). Postoperatively nephrostomy tube drainage was done for a mean of 33 days (range 16 to 51). All patients underwent at least 1 additional percutaneous stone removal procedure after primary percutaneous nephrolithotomy and before stenosis was detected. The mean time to stenosis detection was 9 months (range 2 to 24). Stenosis generally developed in areas corresponding to previous sites of percutaneous access and the degree of narrowing ranged from mild to severe. Mild and moderate stenosis was managed by observation and endoscopic dilation in 2 each. Severe stenosis in 1 patient was associated with significantly impaired ipsilateral renal function. Infundibular stenosis is a rare complication of percutaneous nephrolithotomy. In this series it was associated with prolonged operative time, a large stone burden requiring multiple removal procedures and extended postoperative nephrostomy tube drainage. In most cases stenosis developed at previous access sites within 1 year of initial percutaneous nephrolithotomy. Mild and moderate cases may be treated with observation and endoscopic dilation, respectively, while severe cases may result in renal impairment.

Flexible ureteroscopy in conjunction with in situ lithotripsy for lower pole calculi

Objectives. To demonstrate the efficacy and safety of ureteroscopy as a compromise in treating small and intermediate-size lower pole calculi. The optimal management of lower pole calculi remains controversial. Shock wave lithotripsy is associated with minimal morbidity but with suboptimal stone clearance rates. Conversely, percutaneous nephrostolithotomy has greater morbidity but stone-free rates greater than 90% regardless of size. Methods. Seventy-two patients underwent ureteroscopy for lower pole calculi 2 cm or less (mean 8.7 mm) during a 3-year period. To minimize confounding, 11 patients with additional calculi at other ipsilateral renal sites and 1 patient with large (2.4 cm each) bilateral calculi were excluded. Two patients with bilateral lower pole calculi and four who required a second procedure were included in the analysis. Thus, the final cohort consisted of 60 patients who underwent 66 procedures. Results. Of patients with follow-up longer than 1 month, 79% were stone free after a single procedure, and this improved to 88% after a second procedure in 4 patients. All 7 patients with follow-up less than 1 month had a reduction in stone burden after successful fragmentation. Overall, 8 patients required an auxiliary procedure. No intraoperative complications, and 7 (11%) postoperative complications occurred. Conclusions. Ureteroscopy for lower pole calculi is associated with minimal morbidity and stone-free rates comparable to shock wave lithotripsy for smaller stones. The greatest utility of ureteroscopy is in the management of intermediate-size calculi, for which it has substantially higher stone-free rates and lower repeated treatment rates than does shock wave lithotripsy.

MECHANICAL PERCUSSION, INVERSION AND DIURESIS FOR RESIDUAL LOWER POLE FRAGMENTS AFTER SHOCK WAVE LITHOTRIPSY: A PROSPECTIVE, SINGLE BLIND, RANDOMIZED CONTROLLED TRIAL

We compare the effectiveness of mechanical percussion and inversion with observation for eliminating lower caliceal fragments 3 months after shock wave lithotripsy. At 3 months after shock wave lithotripsy 69 patients with residual lower caliceal fragments 4 mm. or less were randomized to receive either mechanical percussion and inversion or observation for 1 month. The observation group then received crossover mechanical percussion and inversion if fragments persisted. All patients were followed with plain film of the kidneys, ureters and bladder to assess the stone area and stone-free status, and renal tomography or noncontrast spiral computerized tomography to confirm stone-free status. A blinded radiologist reviewed all films. Patients were treated with a mechanical chest percussor applied to the flank while inverted to greater than 60 degrees after receiving 20 mg. furosemide. A total of 35 patients were randomized to receive immediate mechanical percussion and inversion therapy and 34 observation. Of the patients in the observation group 28 subsequently received mechanical percussion and inversion after completing the observation period. The groups were not different in gender, body mass index, side affected, stone location or renal anatomical features. The mechanical percussion and inversion group had a substantially higher stone-free rate than the observation group (40% versus 3%, respectively, p <0.001). The mechanical percussion and inversion group also had a greater improvement in total stone area than controls (-63.3% versus +2.7%, respectively, p <0.001). No significant adverse effects were noted in the mechanical percussion and inversion group. Mechanical percussion and inversion is a safe and effective treatment option for residual lower caliceal fragments 3 months after shock wave lithotripsy. Nearly 50% of patients become stone-free, and stone burden is decreased by 50% in the remainder.

CRITICAL ANALYSIS OF SUPRACOSTAL ACCESS FOR PERCUTANEOUS RENAL SURGERY

Percutaneous renal surgery is currently performed for complex renal calculi as well as for various other endourological indications. In many patients an upper pole nephrostomy tract allows direct access to most of the intrarenal collecting system. Upper pole percutaneous access may be obtained via the supracostal or subcostal approach. The preferred route depends on the location and size of the specific stone or lesion. Previously others have cautioned against the supracostal approach above the 12th rib and many have discouraged an approach above the 11th rib due to concern about the increased risk of intrathoracic complications. We retrospectively assessed the morbidity associated with supracostal percutaneous renal surgery and compared and analyzed the morbidity of the supracostal and subcostal approaches. The records of all patients who underwent upper pole percutaneous renal surgery between November 1993 and July 1999 were retrospectively reviewed. A total of 240 patients underwent percutaneous renal procedures, including 225 for managing symptomatic renal or ureteral stones, that is nonstaghorn calculi in 157, staghorn calculi in 41, proximal ureteral calculi in 12, calculi within a caliceal diverticulum in 6, calculi associated with primary ureteropelvic junction obstruction in 5 and calculi associated with a retained ureteral stent in 4. An additional 15 procedures were done for ureteropelvic junction obstruction (7), intrarenal collecting system tumors (5), a caliceal diverticulum without stones (1), a retained ureteral stent (1) and a ureteral stricture (1). A total of 300 nephrostomy tracts were placed to obtain access to the intrarenal collecting system via the supracostal approach in 98 (32.7%) cases and the subcostal approach in 202 (67.3%). Of the supracostal approaches 72 (73.5%) tracts were above the 12th and 26 (26.5%) were above the 11th rib. The overall complication rate irrespective of percutaneous approach was 8.3% (16.3% for supracostal and 4.5% for subcostal access). Complications included blood transfusion in 7 patients, intraoperative hemothorax/hydrothorax in 5, sepsis/bacteremia in 3, atrial fibrillation in 2, delayed nephropleural fistula in 2, renal artery pseudoaneurysm in 2, deep venous thrombosis/pulmonary embolus in 2, pneumothorax in 1 and subcapsular hematoma in 1. Seven of 8 intrathoracic complications (87.5%) developed in supracostal cases. Percutaneous renal surgery remains an important option for managing complex renal calculi and other upper urinary tract lesions. In our experience it is generally associated with low morbidity. The supracostal approach is often preferred for obtaining intrarenal access to complex renal and proximal ureteral pathology. Because supracostal access tracts are associated with significantly higher intrathoracic and overall complication rates compared to subcostal access tracts, this approach must be used with caution when no other alternatives are available.

RENAL PARENCHYMAL INJURY AFTER STANDARD AND MINI PERCUTANEOUS NEPHROSTOLITHOTOMY

Mini percutaneous nephrostolithotomy was developed for use in children and in adults with a reduced renal reserve to minimize the morbidity and renal parenchymal damage presumed to occur with traditional percutaneous nephrostolithotomy. We compared the extent of renal injury incurred by different sized nephrostomy tracts in female farm pigs undergoing 11 or 30Fr percutaneous nephrostomy. Bilateral percutaneous nephrostomy was attempted via a mid or lower pole calix under fluoroscopic guidance in 6 pigs. In 2 pigs the procedure was unsuccessful on 1 side, leaving 5 successfully established nephrostomy tracts on each side. In each pig the right percutaneous tract was dilated with a 28Fr dilating balloon and a 30Fr Amplatz working sheath (Cook Urological, Spencer, Indiana) was positioned in the collecting system. On the left side an 11Fr sheath (Cook Urological) was placed. The sheaths were removed after 1 hour and nephrostomy tubes (22Fr on the right and 8Fr on the left side) were left in place overnight and then removed. Six weeks later the pigs were sacrificed and the kidneys were harvested. The nephrostomy tracts were identified grossly and examined microscopically, and the fibrotic scar was measured using digital analysis. The volume of scar was estimated using the calculated volume of a cylinder. At kidney harvest all 10 kidneys appeared grossly normal. No intra-abdominal urine collection or perirenal hematoma was noted. Mean estimated scar volume of the 30 and 11Fr tracts was 0.29 and 0.40 cc, which translates into a mean fractional loss of parenchyma of 0.63% and 0.91%, respectively (p not significant). Renal parenchymal damage resulting from the creation of a nephrostomy tract is small compared to overall renal volume regardless of the size of the nephrostomy tract. Consequently there is no advantage to the use of a small access sheath based on renal scarring alone.

Percutaneous management of stones in a patient with sacral agenesis

We report a case of a patient with sacral agenesis and nephrolithiasis in whom percutaneous nephrostolithotomy was used to treat the stone disease. Sacral agenesis is an uncommon congenital anomaly involving the lower vertebral bodies and is associated with urinary tract dysfunction. Nephrolithiasis in a patient with sacral agenesis poses a problem in access for percutaneous nephrostolithotomy because of the associated presence of renal ectopia. We describe our technique and the special considerations necessary for successful access.

RETROGRADE URETEROSCOPIC ENDOPYELOTOMY USING THE HOLMIUM: YAG LASER

We defined the safety and efficacy of retrograde ureteroscopic endopyelotomy using the holmium:YAG laser. Between July 1996 and December 1999 a total of 28 renal units in 21 women and 6 men 7 to 75 years old (mean age 43.5) with ureteropelvic junction obstruction were treated at our institution with retrograde ureteroscopic endopyelotomy. Ureteropelvic junction obstruction was bilateral in 1 case, primary in 20 and secondary in 8. Endoluminal ultrasound was done before endopyelotomy in all cases. Patients with renal calculi underwent antegrade percutaneous nephrostolithotomy and traditional cold knife endopyelotomy. Endoluminal ultrasound revealed posterior and lateral crossing vessels in 5 patients, who did not undergo the endoscopic approach. Retrograde endopyelotomy was performed using the holmium:YAG laser in 23 cases and electrode incision with pure cutting current in 5. Postoperatively a ureteral stent remained indwelling for an average of 6 weeks. Thereafter patients were followed with serial ultrasound, excretory urography and renal scan at 3 to 6-month intervals. We evaluated 28 upper urinary tracts, including 19 (67.9%) with high insertion ureteropelvic junction obstruction and 9 with an annular stricture. As directed by ultrasound images, the incision location was posterolateral, posterior, lateral and posteromedial in 16, 5, 4 and 3 cases, respectively. Followup was available in all cases at a mean of 10 months (range 3 to 35). Success, defined as improved drainage on radiographic study and absent clinical symptoms, was achieved in 19 of the 23 patients (83%) treated with the holmium:YAG laser. Repeat laser incision resulted in a successful outcome in 2 of the 4 treatment failures. There were no acute surgical complications. Retrograde ureteroscopic endopyelotomy with the holmium:YAG laser is safe and minimally invasive therapy for primary and secondary ureteropelvic junction obstruction. Endoluminal ultrasound aids in decision making when retrograde endopyelotomy is done.

Current management of severely encrusted ureteral stents with a large associated stone burden.

We review our recent experience with encrusted retained ureteral stents associated with a large stone burden as well as current endoscopic options available for management. One man and 3 women presented to our department between May 1998 and April 1999 for treatment of an encrusted retained ureteral stent. One patient had a history of 3 episodes of ureteral stent encrustation during the last 6 years. We reviewed the management of these stents and the associated stone burden. Average patient age was 32.5 years (range 25 to 41). Average interval that the encrusted stent remained in place was 7 months (range 3 to 12). In the 3 women pregnancy was associated with the retained stent. All patients required 2 to 6 endourological approaches (average 4.2) performed at 1 or multiple sessions to render them stone-free and stent-free. Postoperatively sepsis in 1 case necessitated a prolonged intensive care unit stay with eventual recovery. Successful management of a retained encrusted stent requires combined endourological approaches. Percutaneous nephrostolithotomy and ureteroscopy are often necessary for treating a severely encrusted stent and the associated stone burden.