Pyelonephritis from Severe Incrustations on Silicone Ureteral Stents: Management

Abber, Jason C.; Kahn, Robert I.

doi:10.1016/s0022-5347(17)51446-9

Cited by 21 publications

(7 citation statements)

References 9 publications

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“…Case reports using hemiacidrin and Suby G solution to dissolve associated stones and encrustation, followed by successful cystoscopic retrieval of the stent, have been described. 29,30 These agents should be reserved for extreme cases, given their irritating effects on the lower urinary tract and the need for close monitoring secondary to potential electrolyte imbalances from systemic absorption.…”

mentioning

confidence: 99%

Encrusted Urinary Stents: Evaluation and Endourologic Management

VanderBrink

Rastinehad

Ost

et al. 2008

Journal of Endourology

102

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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.

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mentioning

confidence: 99%

Encrusted Urinary Stents: Evaluation and Endourologic Management

VanderBrink

Rastinehad

Ost

et al. 2008

Journal of Endourology

102

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“…12 A Successful PCN placement with improvement in renal failure and treatment of initial infectious syndrome was also found in 93% of the patients in a study conducted by Fournier G et al 13 Abber et al reported an obstruction of the ureteral stent resulting from the early onset of incrustation in 5% of cases with accompanying urinary tract infection and subsequent pyelonephritis. 14 Pollard and Macfarlane evaluated symptoms, including irritative bladder complaints, and suprapubic and flank pain, associated with ureteral stents in 20 patients and confirmed that the symptoms disappeared after stent removal. 15 They found no association between the degree of symptoms and stent composition, style or length.…”

Section: Discussionmentioning

confidence: 88%

Percutaneous nephrostomy or double J stenting, which is better modality for obstructive uropathy-a descriptive study

2016

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“…Patients underwent an average of 2.5 (range [1][2][3] procedures. One patient's treatment was made more difficult by an inflammatory ureteral stricture, which resolved after removal of the encrusted stent.…”

Section: Resultsmentioning

confidence: 99%