JKMC | VOL. 5 | NO. 4 | ISSUE 18 | OCT-DEC, 2016

Multimodal management of forgotten encrusted ureteral stents
Dongol UMS, Ghimire R


Abstract:

Background: Endourological management is the main treatment modality for forgotten encrusted ureteral stent. Sometimes extracorporeal shockwave lithotripsy and even open surgery may be needed to remove these forgotten ureteral stents.

Objectives: To evaluate the efficacy and feasibility of different endourological approaches like percutaneous nephrolithotomy,ureteroscopic lithotripsy, cystolithotripsyand extracorporeal shockwave lithotripsy in the treatment of forgotten encrusted ureteral stents.

Methods: Total of ten patients with forgotten encrusted double J stents from Jan 2013 to Nov 2015 were included. Mean age of the patients was 38.4 years (1.5 -5 years). All patients were evaluated for stent encrustation and associated stone burden by X-ray Kidney Ureters and Bladder and Intravenous Urography. Combined endourological procedures like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal shockwave lithotripsy and even open surgery was done to remove these stents. Patients characteristics, indications for stenting, indwelling time, site of encrustation, hospital stay etc were all noted.

Results: Total of ten patients presented to us with forgotten Double J stents. Majority of the patients had undergone surgery before. Out of three patients with large encrustations both in renal pelvis and urinary bladder,one patient underwent percutaneous nephrolithotomy and cystolithotripsy. Rest two patients underwent extracorporeal shockwave lithotripsy for two sessions for renal pelvic encrustation and cystolithotripsy for urinary bladder encrustation.Fourpatients underwent ureteroscopic lithotripsy and cystolithotripsy. Two patients in whom all fractured coils were in urinary bladder, underwent cystolithotripsy. All the stents were removed under C-arm fl uoroscopic guidance. In one patient open ureterolithotomy was done to remove the knotted stent.

Conclusion: The use of Double J stent should be limited to those patients where the benefits override the possible complications. The combination of various endourological techniques and extracorporeal shockwave lithotripsy can achieve effective stent and stone treatment with minimal morbidity and hospital stay.


Keyword : Cystolithotripsy, Extracorporeal shock wave lithotripsy,Percutaneous nephrolithotomy,retrograde ureteroscopy, ureteral stents, ureteric lithotripsy.