1-step removal of encrusted retained ureteral stents.

PURPOSE

Ureteral stents are prone to encrustation, which can create a problem at the time of removal. Reports in the literature describe techniques that require several procedures and anesthetic sessions to effect extraction. We describe our experience with 1-step removal of retained ureteral stents.

MATERIALS AND METHODS

A total of 12 retained calcified ureteral stents in 10 patients were treated between December 1998 and July 2002. The reason for stent placement was nephrolithiasis in 8 patients, ureteral obstruction due to malignancy in 1 and following endopyelotomy in 1. Stents were in place for a mean of 10 months (range 6 to 16). One patient had 2 retained stents in a single ureter. Stents were extracted using a holmium laser. The semirigid ureteroscope and/or flexible ureteroscope was advanced beside the retained ureteral stent and laser was used to fragment stone on and around the stent. The ureteroscope was advanced into the renal pelvis and any stone present was fragmented. The ureteroscope and stent were then removed.

RESULTS

Of the 12 stents 11 were managed by ureteroscopy alone. In 1 patient the upper stone burden was treated through a percutaneous tube previously placed for obstructive pyelonephritis. All patients were treated at 1 anesthetic session. Mean operative time was 93 minutes (range 45 to 225). All except 2 patients were discharged home in 23 hours. In 1 patient a perinephric abscess resolved with computerized tomography guided drainage. One patient required intravenous antibiotics for 48 hours for fever with subsequent resolution. No patients have had ureteral strictures to date.

CONCLUSIONS

Historically the management of retained calcified ureteral stents has involved several operations to render the patient stone-free and stent-free. We describe our approach to this difficult problem with only 1 session in the operating room, minimal morbidity and a short hospital stay.