A Novel Telescopic Access Sheath Method to Manage Encrusted or Knotted Retained Ureteral Stents

Abstract

Purpose: Encrusted and knotted stents may cause serious urologic complications. This study aimed to develop a novel and minimally invasive technique to manage encrusted or knotted retained ureteral stents. Materials and Methods: This technique was used in nine patients with retained stents. Through rigid cystoscopy, the stents were pulled out of the urinary meatus. The access sheath was modified by cutting the distal end of its obturator. The modified access sheath was advanced over the retained stents in a telescopic manner to remove the encrusted and/or knotted stents. Results: Six patients had encrustations, two had knot formation, and one had both encrustation and knot formation. The encrustations were peeled off in the process. The knots were either undone or pulled through the lumen of the access sheath. The retained stents were removed intact from all patients without any complications. Conclusion: The access sheath method described in this article provides a simple alternative for the removal of encrusted or knotted retained stents. However, this technique requires further validation to establish its safety and efficacy.

Will the advances in retrograde intrarenal surgery extinguish percutaneous nephrolithotomy for stones larger than 2 cm?

“…Also, “forgotten stent” can develop into severe encrustation ( 26 ) and its removal may require refined management planning and advanced surgical techniques ( 27 , 28 ). Strategies to prevent such problem include stent judicious use and the implementation of modern technology to keep track of stented patients ( 29 , 30 ).…”