Garza-Montúfar ME. et al., 2025: Classification System for the Treatment of Encrusted Ureteral Stents.
María E Garza-Montúfar 1, Hid F Cordero-Franco 2, Carlos M García-Pérez 3, Juan H Díaz-García 4, Brissia Lazalde 5
1Urology Department, Instituto Mexicano del Seguro Social, Hospial General de Zona N° 33, Monterrey, Nuevo León, México.
2Centro de Investigación Biomédica del Noreste/Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
3Urology Department, Instituto Mexicano del Seguro Social, Unidad de Medicina de Alta Especialidad N° 25, Monterrey, Nuevo León, México.
4División de Estudios de Posgrado e Investigación, Facultad de Medicina y Nutrición, Universidad Juárez del Estado de Durango, Durango, México.
5Departamento de Genética, Facultad de Medicina y Nutrición, Universidad Juárez del Estado de Durango, Durango, Durango, México.
Abstract
Background: We created a classification system for encrusted ureteral stents (ES) (Grading system for Additional lithiasis and uReteral Stent cAlcification -GARSA-, I-III grades), we demonstrate its utility for predicting the surgical outcome and the need of complex surgery.
Methods: Retrospective review of patients with ES; clinico-demographics, additional lithiasis (AL), stent calcification characteristics, surgeries performed, complications and stone free rate were collected. Chi-square was used to compare the categorical variables and Kruskal-Wallis test for the comparison > 2 numerical groups; a p-value < .05 was considered significant.
Results: We included 190 ES; 163 (85.8%) stents underwent one-time surgical removal. Most Grade I catheters were removed in a single surgery, without invasive/multimodal therapy; Grade II-III catheters required multimodal and invasive therapies. The presence of AL in kidney increased the number of surgical interventions performed in Grade I/II catheters (p < 0.05) and the likelihood of requiring multimodal (Grade I: 90%, Grade II: 83.3%, Grade III: 100%) or invasive surgery (Grade I: 38.1%, Grade II 58.3%, Grade III 90.9%) to achieve successful treatment.
Conclusions: Incorporating both the calcified stent characteristics and the presence of AL, GARSA score can be used to determine the selection of the optimal surgical approach for patients with encrusted stents.
Urologia. 2025 Jul 10:3915603251351767. doi: 10.1177/03915603251351767. Epub ahead of print. PMID: 40635582
Comments 1
It is well recognized that stent calcifications (encrustations) add significant problems to stent removal. Each case presents specific difficulties related to degree of encrustations and their location on the stent. The authors suggest a classification system (GARSA) in addition to other urinary tract stones. Different scores are given for encrustations in the kidney, ureter and bladder. The system is of obvious value when the results of stent removal need to be statistically analyzed. One problem is, however, that there are no standard methods for stent removal that directly can be related to the scoring.
The method used for stent removal is based on endoscopy and/or invasive surgery. Although SWL in several of the situations might be an excellent low-invasive and gentle procedure, it is not mentioned in the article. Moreover, some encrustations might be susceptible to chemolytic treatment that albeit need of percutaneous puncture, significantly can reduce the complications in these patients. Therefore, it would have been of interest if the authors had added information on the chemical composition of the encrustations and/or stones.
Hans-Göran Tiselius