Encrusted Urinary Stents: Evaluation and Endourologic Management

Abstract

Ureteral stents and nephrostomy tubes have been used extensively in urology. Attendant to their use are their associated morbidities, such as pain, infection, and encrustation. We review the literature on the subject of the encrusted stents and drainage catheters, discuss the risk factors for encrustation, and describe the endourologic evaluation and management of these encrusted and retained urinary drainage devices. A variety of factors contribute to the rate at which this process occurs, including the material of the stent or catheter, urine composition, and duration of use. The risk of stent encrustation is increased in patients with a history of urolithiasis and with progressively longer indwelling times. Novel stent designs incorporating antimicrobial eluting stents and stents with enzymes to degrade urinary oxalate have shown promise in vitro to minimize stent morbidity. Imaging plays a pivotal role in determining the appropriate surgical management of the encrusted and retained stent. In cases in which encrustation is minimal, extracorporeal shock wave lithotripsy has been used with high success rate. Calcifications along the ureteral component of the stent can be treated with retrograde ureteroscopy and laser lithotripsy while the percutaneous route is the preferred primary approach when stone size is greater than 2 cm and/or if there is associated significant encrustation on the proximal ureteral end of the stent. It is not unusual to need multiple sessions to successfully render the patient stent and stone free, depending on which modalities are used. A computerized tracking system for patients with indwelling ureteral stents has been advocated to reduce the number of "forgotten" stents. Finally, it is of paramount importance that the treating urologist communicates clearly to the patient the presence of any internal urologic stents, the temporary intent of their use, risks with prolonged indwelling times, and the need for appropriate follow-up to avoid complications of encrustation.

Tricks and tacks in the management of the forgotten double J stent

“…Many investigators have employed ESWL, URS-Se, laserlithotripsy, PCNL, chemolysis using various chemolytic agents administered via a percutaneous nephrostomy tube, and open surgery either alone or in combination with other procedures. 15,16 Comparatively, single procedure removal of encrusted stent has also been reported, but it should be avoided for severely encrusted stents. 5 As per the literature over enthusiastic single-stage removal is discouraged in case of long intraoperative time, and it is better to stage the procedure.…”

A rare complication after renal transplantation: Forgotten stent

“…Urine pH can increases due to urea splitting bacterias that decompose urea and cause magnesium-calcium-phosphate cyristals accumulation on the DJS. Encrustation is highly related with urine composition, bacterial colonisation and duration of staying of the stent (6). There is no proofed gold standard treatment for encrusted stents.…”

Vesical calculus on the end of forgotten DJ stent: a case report

“…Various complications including migration, fragmentation and stone formation still occur especially if the stent is left in situ for long time. 1,2 This necessitates the need to remove stents as early as possible. Counseling before and after the procedure regarding DJ stent placement and its removal plays a vital role to avoid the retained/forgotten stent and in turn avoiding the morbidity associated with the stent.…”