Bukkapatnam Raviender, Seigne John, Helal Mohamed
University of South Florida College of Medicine, Tampa, USA.
J Urol. 2003 Oct;170(4 Pt 1):1111-4. doi: 10.1097/01.ju.0000086042.36616.1b.
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.
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.
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.
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.
输尿管支架易于形成结石，这在取出时可能会引发问题。文献报道的技术需要多次操作和麻醉才能实现取出。我们描述了我们一次性取出留置输尿管支架的经验。
1998年12月至2002年7月期间，对10例患者的12个留置钙化输尿管支架进行了治疗。放置支架的原因：8例为肾结石，1例为恶性肿瘤导致的输尿管梗阻，1例为肾盂切开术后。支架平均留置时间为10个月（6至16个月）。1例患者在单根输尿管中有2个留置支架。使用钬激光取出支架。将半硬性输尿管镜和/或软性输尿管镜推进到留置的输尿管支架旁，用激光将支架上及周围的结石击碎。将输尿管镜推进到肾盂，如有结石则将其击碎。然后取出输尿管镜和支架。
12个支架中有11个仅通过输尿管镜检查处理。1例患者的上尿路结石负荷通过先前因梗阻性肾盂肾炎而放置的经皮肾造瘘管进行处理。所有患者均在一次麻醉下接受治疗。平均手术时间为93分钟（45至225分钟）。除2例患者外，所有患者均在23小时内出院。1例患者的肾周脓肿通过计算机断层扫描引导下引流得以消退。1例患者因发热接受了48小时的静脉抗生素治疗，随后症状缓解。迄今为止，没有患者出现输尿管狭窄。
过去，处理留置钙化输尿管支架需要多次手术以使患者结石清除且无支架。我们描述了针对这个难题的方法，仅需在手术室进行一次操作，发病率极低且住院时间短。
