Retained Ureteral Stents at a Tertiary Referral Stone Center-Who is at Risk?
Rajat Jain1, Hemant Chaparala1, Mohamed Omar1
1Department of Urology, Cleveland Clinic, Cleveland, Ohio.
Urology Practice
|June 14, 2023
Summary
Preventable encrustation of retained ureteral stents causes morbidity. Longer indwelling time and prior stone history predict encrustation severity, increasing the need for multiple procedures.
Area of Science:
- Urology
- Nephrology
- Medical Device Management
Background:
- Retained ureteral stents can lead to significant morbidity due to encrustation.
- Managing encrusted stents presents a clinical challenge.
Purpose of the Study:
- To examine the treatment of patients with retained and encrusted ureteral stents.
- To identify predictors of stent encrustation and associated management complexities.
Main Methods:
- Retrospective analysis of a prospectively collected stone registry.
- Identification of patients with retained, encrusted stents and a control group.
- Data collection included demographics, medical history, and surgical outcomes; encrustation graded using the forgotten, encrusted, calcified system.
Main Results:
- 66 patients with encrusted stents and 4,962 controls were identified.
- Longer indwelling time and prior stone history predicted higher encrustation grades.
- Patients with prior stone history, higher encrustation grade, and upper coil encrustation were more likely to require multiple procedures.
Conclusions:
- Stent encrustation is preventable and linked to significant morbidity.
- Indwelling time and stone disease history are key predictors of encrustation.
- Upper coil encrustation complicates management, often necessitating repeat procedures.
Related Concept Videos
01:30Urinary Tract Calculi III: Medical Management
9
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
9
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
16
Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
16
01:28Urinary Tract Calculi I: Introduction
19
Renal calculi, or kidney stones, are solid deposits of minerals and salts formed inside the kidneys. In medical terminology, "calculus" refers to the stone itself, while "lithiasis" describes the process of stone formation. Depending on their location within the urinary system, these stones may be classified as either urolithiasis, when situated within the urinary tract, or nephrolithiasis, when located within the kidneys. Each term signifies the specific impact of the stone.Predisposition...
19
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
11
Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
11
01:28Urinary Tract Calculi V: Nursing Management
14
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
14
01:25Urinary Tract Calculi VI: Surgical Management
11
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
11