Purpose: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. Materials and Methods: From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. Results: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. Conclusion: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.
The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus.The distal end of the VP shunt is commonly placed in the peritoneal cavity. Various complications of the distal end of the shunt have been described in the literature.We report an unusual case of perforation of the distal end of the VP shunt into the bladder, with vesical calculus formation.
Purpose: We report our experience with the use of povidone iodine instillation into the renal pelvis for the treatment of chyluria. Materials and Methods: From August 2006 to November 2008, 26 patients with chyluria were treated. There were 18 males and 8 females ranging from 24–55 years of age. Cystoscopic localization of chylous efflux was done. Povidone iodine as a sclerosing agent was instilled through a ureteric catheter placed in the renal pelvis. A total of 9 doses were given at 8-hour intervals for 3 days. Unilateral instillation was done in 20 cases, and bilateral instillation was done in 6 patients. Results: Twenty-one of 26 patients showed complete clearance. In 4 patients, recurrence was noted and a repeat injection was given after 4 weeks, with success, in 2 patients. The other two patients required chylolymphatic disconnection. One patient was lost to follow-up. Conclusion: Our experience shows that povidone iodine is a safe and effective sclerosing agent in the management of chyluria.
The placement of stents has been a standard practice since 1967. The advantage of routine stenting is that it minimizes postoperative ureteral obstruction and renal colic that may result from ureteral oedema caused by balloon dilatation or stone manipulation. There are various disadvantages resulting from it including flank pain, voiding symptoms, infections, stent related stone formation and encrustation. Various studies recommend them to be used only for procedures with complications such as ureteric injury or if a stone fragment remained at the end of the procedure. The aim of our study was to assess the need for routine ureteral stenting after uncomplicated ureteroscopic stone removal. MATERIALS AND METHODSThis study was conducted at Rajarajeshwari Medical College and Hospital, Bangalore, as a prospective randomized controlled trial in Department of Urology between January 2015 and May 2016. In this hospital-based prospective, comparative study, all patients were treated by ureteroscopic lithotripsy. Following the procedure, patients were randomized to the non-stented (n=44) who had no stent placed at the end of the operation and stented (n=52) group having Double DJ stent placement. The assessment criteria included operative time, success rate, postoperative analgesia, complications including (Flank pain, dysuria, haematuria, frequency/urgency), UTI, fever, rehospitalisation and hospital stay. RESULTSThe two groups were comparable with respect to baseline variables of age, gender, mean stone size, side of stone and number of patients turning for radiological follow-up at 3 months. The mean operative time was 38.12±10.76 minutes in the stented group and 32.22±6.72 minutes in the non-stented group. However, this difference was statistically insignificant. There was no significant difference in the two treatment groups with regard to use of intracorporeal lithotripsy. Ureteral dilatation was not required in any patient in both groups. A successful outcome was achieved in 100% of the cases in both groups. Patients with double J stents had statistically significantly more frequency/urgency, dysuria and need of analgesics compared to those without stents. There was no significant difference between the three groups regarding haematuria, fever, flank pain, urinary tract infection, rehospitalisation and mean hospital stay. CONCLUSIONRoutine ureteral stenting does not appear to be warranted in those patients who do not require ureteral dilation during ureteroscopic procedures. Patients without stents had significantly less pain, fewer urinary symptoms and decreased analgesic use postoperatively. Another advantage is cost effectiveness and avoidance of cystoscopy for stent removal.
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