Department of Urology, Osmania General Hospital, Hyderabad, Andhra Pradesh, India.
Int Braz J Urol. 2010 Jul-Aug;36(4):420-9. doi: 10.1590/s1677-55382010000400005.
To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation.
From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function.
In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases.
Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.
介绍我们的经验并讨论处理遗忘性结石形成的包埋输尿管支架的各种腔内泌尿外科方法。
自 2006 年 7 月至 2008 年 12 月，对 14 例（男 11 例，女 3 例）包埋输尿管支架的患者进行分析。支架留置时间平均为 4.9 年（1 至 12 年）。平片放射学用于评估支架的包埋、结石负荷和碎片。静脉尿路造影和 Tc99m 二乙三胺五乙酸肾图用于评估肾功能。
在 7 例患者中，整个支架被包埋，在 3 例患者中，包埋仅限于支架的输尿管和下部线圈部分，2 例患者有下部线圈包埋，2 例患者观察到最小的包埋。5 例患者进行经皮肾镜碎石术，9 例患者进行逆行输尿管镜检查和腔内碎石术。8 例患者采用膀胱镜碎石术处理包埋支架的远端线圈。2 例包埋支架较小的患者采用单纯膀胱镜取出。1 例回肠造口术和保留支架的患者采用Looposcopy 取出支架。仅 1 例患者需要开放式手术取出支架。14 例患者中有 13 例在一次手术中清除结石和支架。除 2 例外，所有支架均完整取出，对包埋和钙化的结石分析显示大多数病例为草酸钙和磷酸钙。
遗忘性包埋支架的腔内处理非常成功，通常避免了开放式手术技术的需要。
