Ali RN. et al., 2025: Multi-Modal Approach to Salvage: Extracorporeal Shock Wave Lithotripsy and Flexible Ureteroscopy for Encrusted DJ Stent Removal in Renal Allograft-A Case Report and Literature Review.

Rao Nouman Ali, Adeel Anwaar, Wajiha Irfan, Farooq Hameed, Inam Ul Haq, Riyan Imtiaz Karamat, Aymar Akilimali
Clin Case Rep. 2025 Sep 16;13(9):e70895. doi: 10.1002/ccr3.70895  FREE FULL TEXT

Abstract

DJ stents are critical for maintaining renal drainage in post-surgical and obstructive conditions, but they must be removed within 4-6 weeks to prevent serious complications. This case highlights the successful removal of an encrusted, forgotten DJ stent through extracorporeal shock wave lithotripsy (ESWL) in a renal transplant patient, resulting in an uneventful recovery.

Comment Hans-Göran Tiselius

The authors show that SWL is an excellent tool for removal of encrusted stents. In this particular case the stent had been inserted in a transplanted kidney and it is of fundamental importance to be as careful and gentle as possible to avoid tissue damage.
In the reviewer’s opinion the use of SWL is an excellent choice. Solid material in the upper and lower loops as well as along the whole catheter can be disintegrated in one or several sessions. Inasmuch as SWL in such cases can be completed without anesthesia, it is possible to solve the problem in a convenient way.
Given the need of being extremely careful, there is no place for percutaneous surgery or puncture which excludes chemolysis. Nevertheless, it might be of value to determine the chemical nature of the encrustations because in case of struvite on the bladder loop dissolution might be considered.
In the Table in the article there are patients with stents retained during short as well as long periods, but in only two of thirteen patients did the urologists apply SWL.

Hans-Göran Tiselius