Alnadhari I et a., 2019: Treatment of retained encrusted ureteral Double-J stent
Alnadhari I, Alwan MA, Salah MA, Ghilan AM.
Urology and Nephrology Center, at Al-Thawra Modern General and Teaching Hospital, Sana'a, Yemen; Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra.
OBJECTIVES: We conducted this study to evaluate patients with retained encrusted ureteral stents, identify the predisposing factors and present our experience in the management of such challenging problem. MATERIALS AND METHODS: This prospective study was carried out in the period from May 2007 to February 2011 at the Urology and Nephrology Center, Al-Thawra General Hospital, Sana'a, Yemen. 40 patients with retained encrusted ureteric stents were treated at our center. All patients were initially evaluated with a radiographic imaging for assessment of stent encrustation and stone burden. Treatment decisions were based on the site and severity of encrustations in the renal pelvis, ureter and bladder and on our technical situation and availability of instrumentations. Multi-modal approaches ranging from extracorporeal shock wave lithotripsy (ESWL) to endourological and open urologic procedures were used to achieve stent removal. RESULTS: A total of 90 urological procedures were performed to render all 40 patients stent and stone free. The average duration of stent remained indwelling was 24.2 months (range 4 months -16 years). All patients were managed either by minimally or more invasive multi-modal endourological approaches. For upper coil encrustation percutaneous nephrolithotripsy was performed in eight patients, pyelolithotomy in two patients and ESWL in three patients. Encrustation of the body was treated initially by ESWL, followed by retrograde ureteroscopic manipulation in 12 patients. Lower coil encrustation was successfully managed by cystolitholapaxy in seven patients and one patient required cystolithotomy. Cystolithotomy, pyelolithotomy and ureterolithotomy were carried out in two patients. Two patients who had large burden bladder and kidney stones with loss of kidney function underwent nephrectomy and cystolithotomy. CONCLUSIONS: The retrieval of severely encrusted retained ureteral stent and its associated stone burden poses a real management challenge for urologists due to the need for multimodal procedures and the lack of standardized treatment plan.
Arch Ital Urol Androl. 2019 Jan 18;90(4):265-269. doi: 10.4081/aiua.2018.4.265
This report emphasizes the need to have a strict follow-up plan for patients with internal stents. Unfortunately, in many places and for some patients such a routine is failing and the patient returns at a very late occasion with encrusted stents, sometimes presenting a huge clinical challenge. Two such cases are presented in this article. Although the authors refer to technical and organizational shortcomings, they undoubtedly had sufficient expertise to solve these complicated problems in a successful way. For these results the authors should be congratulated!
Several treatment modalities were applied: SWL, URS, PNL, ureterolithotomy, pyelolithotomy and cystolithotomy.
It had been of great interest if the authors had had the chance to analyze stone composition.
In the case some of their patients had encrustations composed of infection stone material, chemolytic dissolution treatment might have been useful in combination with SWL and other endoscopic or surgical procedures.