Forgotten, Encrusted Ureteral Stents: Removal - Multimodal Endourologic Approach.

Area of Science:

• Urology
• Endourology
• Nephrology

Background:

• Forgotten, encrusted Double-J (D/J) ureteral stents present a complex clinical challenge in urologic practice.
• Major complications include infection, impaired renal function, migration, encrustation, and stone formation.
• A definitive consensus on the optimal therapeutic strategy remains elusive.

Purpose of the Study:

• To present the experience with endoscopic management of forgotten, encrusted ureteral stents.
• To discuss multimodal endourologic approaches for treating these challenging cases.
• To evaluate the safety and efficacy of tailored treatment strategies.

Main Methods:

• Prospective observational study of 29 patients with 35 encrusted ureteral stents (indwelling 5-78 months).
• Evaluation included urine culture, renal function tests, and plain radiography for encrustation and stone burden.
• Treatment decisions were based on clinical presentation, encrustation degree, stone burden, and imaging findings.

Main Results:

• A mean of 2.8 procedures (range: 1-7) were required per patient.
• Extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrostomy were common preoperative interventions.
• Retrograde ureteroscopy with intracorporeal lithotripsy (URS & ICPL) and cystolitholapaxy (CLL) were frequently employed.
• All stents and associated stones were successfully removed with minor complications such as hematuria and urosepsis.

Conclusions:

• Multimodal endourologic approaches offer a safe and effective strategy for removing forgotten, encrusted D/J stents.
• Treatment must be individualized based on the extent of encrustation and associated stone burden.
• Preoperative imaging and negative urine cultures are crucial for successful stent removal.