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• W2036667015 abstract "You have accessJournal of UrologyInfertility, Sexual Dysfunction, Trauma & Teaching Techniques1 Apr 2010V1402 THE ENDOUROLOGIC MANAGEMENT OF FORGOTTEN URETERAL STENTS Arturo Colon-Herdman, James Johannes, and Demetrius H. Bagley Arturo Colon-HerdmanArturo Colon-Herdman More articles by this author , James JohannesJames Johannes More articles by this author , and Demetrius H. BagleyDemetrius H. Bagley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1073AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retained, encrusted ureteral stents are a challenging surgical problem. We present our experience with their endoscopic management, discuss treatment options as well as analyze some of the published data on the treatment of this complication. METHODS Three encrusted stents and their treatment are shown. Management modalities with ultrasonic lithotripsy, holmium laser and electrohydraulic lithotripsy (EHL) are presented. In addition, we reviewed the literature on this subject by searching Pubmed and Medline from January 1989 to April 2009. Electronic searches were limited to the english language using key words “ureteral stent”, “forgotten”, “encrusted”, “calcified”, “overlooked” and “retained”. Relevant articles were reviewed and management approaches evaluated. Indwelling time, morbidity and mortality as well as stone former data was obtained. RESULTS In our literature review we found 38 relevant articles and available data from 343 calcified stents in 291 patients were pooled. Mean indwelling time was 23.26 months (Range 3 months – 18 years). Treatment decision algorithms proposed have involved stone burden classification and grading of stent calcification. Laparoscopy, shockwave lithotripsy, ureteroscopy (URS) and multimodal approaches have been described for definitive management. A mean of 2.1 procedures are required for complete stent extraction. 211 patients had reported history of lithiasis vs 52 with no reported history. Potential complications from retained stents include pyelonephritis, diminished renal function, sepsis and chronic renal failure. Mortality directly related to the calcified stent was demonstrated in 5 cases in the reported literature (1.5%). For our three patients, mean age was 46.6 years (29 years to 64 years), and mean duration of stents in the urinary system was 16.5 months (9 months to 2 years). Two patients were treated with URS alone, one was treated with percutaneous nephrolithotomy and URS. All stents and the associated stones were removed without complications. CONCLUSIONS Combined endourologic techniques can achieve safe removal of encrusted stents. Retained, encrusted ureteral stents can cause significant morbidity to the patient, are potentially lethal and, at times, are very difficult to manage requiring multiple procedures. management of retained, encrusted ureteral stents generally requires a multimodal approach that must be individualized for each patient. Philadelphia, PA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e541 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arturo Colon-Herdman More articles by this author James Johannes More articles by this author Demetrius H. Bagley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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