Endourological Management of Forgotten Encrusted Ureteral Stents

Murthy, Kusuma V. R.; Reddy, S. Jayaram; Prasad, Devendra

doi:10.1590/s1677-55382010000400005

Cited by 43 publications

(56 citation statements)

References 31 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patient and sometimes physician compliance issues lead to stents being forgotten [14]. Poor compliance of the patients represents the main cause [15], which is reflected in our study as well. Proper information and education of the patient regarding the need for stent removal or change is necessary.…”

Section: Discussionsupporting

confidence: 53%

“…A renal scan may be done to document the function. Murthy et al found Bno additional benefit with the use of NCCT^ [15]. In our opinion, NCCT should be done in all the cases where indwelling time is more than 1 year as the stone burden may be radiolucent on plain X-ray.…”

Section: Discussionmentioning

confidence: 86%

“…Single procedure removal of encrusted stent has also been reported [15,20], but it should be avoided for severely encrusted stents where long intraoperative times are expected, large stone burden, and for patients with multiple comorbidities. In case of long intraoperative time, over enthusiastic single-stage removal is discouraged, and it is better to stage the procedure.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Forgotten Reminders: an Experience with Managing 28 Forgotten Double-J Stents and Management of Related Complications

et al. 2015

View full text Add to dashboard Cite

Combinations of extracorporeal shockwave lithotripsy (ESWL) and endourological and open surgery have been used for management of forgotten double-J (DJ) stents; however, there are only a few case reports or case series in literature. We present our experience of managing 28 cases of forgotten ureteric stents of whom three patients died because of complications after intervention. We retrospectively reviewed the hospital records of 28 cases of forgotten DJ stents from 2000 to 2013. The details reviewed included indications for stent placement, indwelling time, presenting complaints, laboratory, radiographic, nuclear scan findings, management techniques, and complications. Extensive review of literature was done. Mean patient age was 37.7±14 years. Mean indwelling time was 102.9 months. The commonest presenting complaints were irritative voiding symptoms and hematuria. Nineteen (67.8 %) of the stents were complicated. The complicated stents were managed by a combination of endourological techniques and ESWL. Six (21.5 %) patients presented with renal failure. Three patients died of complications. Forgotten DJ stent can be a lethal yet entirely preventable complication. Preoperative imaging with a noncontrast CT is essential especially in long indwelling time, especially to evaluate stone burden at the upper end of the stent. A stepwise approach should be used for management. Where long operative times are expected, the procedure must be staged.Combined endourological procedures are almost always successful in managing these challenging cases.

show abstract

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Forgotten Reminders: an Experience with Managing 28 Forgotten Double-J Stents and Management of Related Complications

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Recently, multiple endourological approaches and open surgery have been developed to remove the stents in patients with stent-related complications. An endourological procedure is widely accepted for removing ureteral stents, which is more efficient with less wound complications and shorter recovery times than open surgery (6,7). The present study reports a rare case of a patient with a coiled D-J stent which was not removed for 6 years, which resulted in the development of encrustation and was extracted successfully by cystourethroscopy with holmium laser lithotripsy.…”

Section: Introductionmentioning

confidence: 83%

Use of cystourethroscopy to remove an indwelling double-J ureteral stent 6 years following simultaneous radical sigmoid colon cancer and partial bladder resection: A case report

Zhang

Wang

2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract. Ureteral stents are widely used to ensure good urinary drainage and to relieve obstruction, pain and infection during urologic procedures. However, long-term indwelling ureteral stents can cause various complications, such as encrustation, hematuria and infection. Here, the case of an 88-year-old man who had undergone simultaneous radical resection of sigmoid colon cancer and partial resection of the bladder 6 years prior is presented. The patient complained of urinary frequency and urgency, dysuria and intermittent fever. A kidney ureter bladder X-ray examination revealed the presence of an entire coiled double-J stent with calculi from the kidney to the bladder. A computed tomography scan revealed mild hydronephrosis of the left kidney and one J end of the stent in the bladder. The stent was removed successfully by cystourethroscopy and holmium laser lithotripsy. This report describes the clinical experience of the removal of a long-term stent by endoscopic manipulation.

show abstract

“…[12][13][14][15][16][17][18][19][20] Although there are no formal guidelines in the management of encrusted double-J stents, 15 several authors have reported their series and proposed algorithms: some with multiple sequential surgical techniques; 15,[19][20][21][22][23] others with a one-step approach. 18,24 Even in this single approach technique, after cystolithopaxy or URS in lithotomy position, the patient must be turned prone for PCNL.…”

Section: Introductionmentioning

confidence: 99%

Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

Marchini

Torricelli

Mazzucchi

et al. 2015

CUAJ

View full text Add to dashboard Cite

The management of encrusted ureteral stents is costly, time consuming and may be risky for the patient and challenging for the urologist. Treatment modalities for encrusted stents include extracorporeal shock wave lithotripsy, cystolithopaxy, rigid or flexible ureteroscopy with intracorporeal lithotripsy, percutaneous nephrolithotomy, open surgery, and a combination of those methods. In this study we describe the management of severe forgotten encrusted ureteral stents in 3 female patients using a prone splitleg position. This position allows us to effectively treat any site and degree of stent encrustation in a single-session approach with the patient in the same position during the whole procedure. All patients were rendered stent and stone free. No complications occurred. IntroductionIndwelling ureteral stents were introduced in 1967 and were instrumental in the advance of endourology.1 Ureteral stents are mainly used to manage ureteral obstruction due to intrinsic or extrinsic causes (e.g., urolithiasis, strictures, and malignancy) or after any ureteral surgery.1-4 Modern ureteral stents are usually designed in a double-pigtail configuration and are composed of polyurethane and/or polyethylene.5 New biomaterials and ureteral stent coatings, such as heparin and diamond-like carbon compounds, may reduce infection and encrustation rates.6-8 Nevertheless, underlying stone-forming conditions, pregnancy, and total indwelling-stent time affect the level of encrustation. Stent encrustation rates may increase from 9.2% at <6 weeks to 76.3% at >12 weeks. 9The management of encrusted ureteral stents is costly, time consuming and may be risky for the patient and challenging for the urologist. 10 The degree and site of encrustation are important considerations when dealing with forgotten stents. The term ''forgotten, encrusted, calcified (FECal)'' double-J ureteral stent was created to describe stents which cannot be removed cystoscopically without the aid of other auxiliary measures due to encrustation and/or stone formation. 11 The two most severe types of stent encrustation are Grade IV (circular encrustations completely encasing both of the pigtail portions of the stent) and Grade V (diffuse and bulky encrustations completely encasing both of the pigtail and ureteral portions of stent).11 The ideal method for stent encrustation image evaluation is the non-contrast computed tomography (NCCT), as the standard kidney-ureter-bladder x-ray may miss minor encrustations which can also intricate their removal.Treatment modalities for encrusted stents include extracorporeal shock wave lithotripsy (SWL), cystolithotopaxy, retrograde rigid or flexible ureteroscopy with intracorporeal lithotripsy (URS), percutaneous nephrolithotomy (PCNL), open surgery, and a combination of those methods. [12][13][14][15][16][17][18][19][20] Although there are no formal guidelines in the management of encrusted double-J stents, 15 several authors have reported their series and proposed algorithms: some with multiple sequential surgical t...

show abstract

Endourological Management of Forgotten Encrusted Ureteral Stents

Cited by 43 publications

References 31 publications

Forgotten Reminders: an Experience with Managing 28 Forgotten Double-J Stents and Management of Related Complications

Forgotten Reminders: an Experience with Managing 28 Forgotten Double-J Stents and Management of Related Complications

Use of cystourethroscopy to remove an indwelling double-J ureteral stent 6 years following simultaneous radical sigmoid colon cancer and partial bladder resection: A case report

Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

Contact Info

Product

Resources

About