Total endoscopic management of the encrusted ureteral stent under a single anaesthesia

OBJECTIVE: Stented patients lost to follow up may return with large stone burdens encrusting the stent. The study describes total endoscopic management under one anaesthesia to remove such stents. METHODS: A similar approach was done in all cases. Cystoscopic Holmium: YAG (Ho) or electrohydraulic lithotripsy (EHL) removed the bladder calculus. The bladder portion of stent was cut with endoscopic scissors and removed. The patient was repositioned prone for percutaneous access and nephrolithotomy (PCNY), using either ultrasound, EHL, or Ho. The remaining cephalic portion of stent was removed percutaneously. A universal stent was placed and removed one week later. RESULTS: Eleven patients with 12 ureteral stents left indwelling over one year presented with significant stone burden both in the bladder and kidney. Seven patients had failed extracorporeal shock wave lithotripsy (ESWL) prior to referral. One patient with biolateral encrusted stents had both stents treated under one anaesthesia. The average bladder and kidney stone burdens measured 4 and 6 cm, respectively. The median anaesthesia time was 3.5 hours. No patient required transfusion. Ten of eleven patients were rendered stone-free in one procedure. One patient with a complete staghorn calculus was rendered stone-free by post-PCNL ESWL for a residual calyceal stone. CONCLUSIONS: Total endoscopic management of the encrusted ureteral stent accomplishes safe, effective stone and stent treatment under one anaesthetic. Urologists may wish to consider this strategy when ESWL is unlikely to eradicate large stone burdens on encrusted stents.