Tsaturyan A. et al., 2023: Endoscopic management of encrusted ureteral stents: outcomes and tips and tricks.
Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
Department of Urology, Erebouni Medical Center, Yerevan, Armenia.
Department of Urology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
Department of Anesthesiology and ICU, University of Patras, Patras, Greece.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Abstract
Purpose: To report our experience in the management of encrusted ureteral stents (EUS) and provide technical insight of our endourological approaches for difficult scenarios posed by this entity.
Materials and methods: A retrospective evaluation of a longitudinally collected database of 58 patients with encrusted US between December 2012 and May 2022 was performed. The ureteral stents were initially inserted due to obstructive uropathy, pyelonephritis or after a successful endoscopic procedure for urolithiasis. A combination of antegrade/retrograde treatment in single or multiple sessions took place for the retrieval of the encrusted stents. Non-contrast enhanced computer tomography was used for the follow-up of the patients at 1-month after the removal of the encrusted stent.
Results: Overall 58 patients, 39 males and 19 females with a median age of 51 years old were included in the study. Indwelling time was < 6 months, 6-12 months and > 12 months in 22%, 57% and 21% of the cases, respectively. All US were successfully removed. Semi-rigid ureteroscopy (URS) and flexible ureteroscopy (fURS) were used in 90% of the cases. In 10% of the cases, a second-stage percutaneous nephrolithotomy (PCNL) or endoscopic combined intrarenal surgery (ECIRS) was performed. All US were successfully released. Stone-free rate was 84% at 1-month. Overall complication rate was 10.5% (mostly postoperative fevers, 5.4%).
Conclusion: Removal of the encrusted US is a challenging procedure. Appropriate decision-making and knowledge of specific tricks may result in safe and successful management of significant EUS.
World J Urol. 2023 May;41(5):1415-1421. doi: 10.1007/s00345-023-04361-8. Epub 2023 Apr 6.PMID: 37024556
Comments 1
Undoubtedly, encrusted stents present a challenge to the responsible urologist. The solution of the clinical problem can be accomplished in different ways. The authors present their experience with 58 internal stents complicated by deposited crystalline material, all patients were treated with an endourological approach. Although SWL briefly is mentioned in the Discussion, none of the patients was treated with a least invasive approach. There are no images presented of the encrusted stents and it is of course beyond my possibility to present alternatives to the endourological approach. Nevertheless, it is likely that at least some of the stents could have been treated with SWL.
My own approach when I encountered encrusted stents always was to be low-invasive. Crystalline material attached to any part of the stent can be disintegrated and dislodged with shock waves. Thereby the “naked” stent usually was rather easy to extract cystoscopically.
There is no information on the composition of the encrustations, but in case of large crystal masses of infection origin, additional percutaneous chemolysis is a very gentle procedure.
Most certainly this report reflects the authors’ enthusiasm for endoscopic procedures, but a low-invasive approach, also if carried out in more than one session might have been an attractive alternative at least for some of the patients.
To completely understand the indications for endourology in these 58 patients, it had been necessary to see images of the stents. These are not shown in the article, neither in the supplementary material referred to in the text. Nevertheless, it is likely that at least some of the patients might have benefitted from SWL without anesthesia also if more than one session had been necessary.
Hans-Göran Tiselius