Single session removal of encrusted double J stent using a simultaneous endourological approach: A case series

Double J (DJ) stent encrustation is a serious urological complication that often requires complex surgical management. This study evaluated the feasibility, safety, and efficacy of a novel combined antegrade and retrograde endourological approach to remove encrusted DJ stents. A retrospective analysis was conducted involving 12 patients treated between May 2020 and April 2025 at a tertiary university hospital. All patients underwent simultaneous antegrade and retrograde procedures. The inclusion criterion was encrustation of both the renal and vesical coils, with some cases involving ureteral encrustation. The visual grading for the ureteral encrusted stent classification system was used to evaluate surgical complexity. Postoperative outcomes, complications, and stone-free rates were assessed. The mean age of patients was 41.17 ± 20.74 years, with a mean stent indwelling time of 17.08 ± 12.80 months. The average operative time was 72.92 ± 45.90 minutes. All procedures were performed using a single-tract access, and all patients became stent-free within 1 session. Tubeless percutaneous nephrolithotomy was performed in 11 patients; 1 patient had a Clavien-Dindo grade II complication. Otherwise, no major complications (grades III-V) were observed. The mean decrease in hemoglobin level was statistically significant yet clinically negligible, and no transfusions were required. The simultaneous combined endourological approach in the supine position is feasible, effective, and safe for removing encrusted DJ stents. Performing antegrade and retrograde procedures concurrently by 2 surgeons is efficient as it reduces the operative time and potentially minimizes healthcare burden. Although promising, further prospective studies are warranted to confirm these findings and establish broader clinical applicability.