Ulker Volkan, Celik Orcun
Department of Urology, Tepecik Training and Research Hospital, Health Sciences University, 35180 Izmir, Turkey.
Medicina (Kaunas). 2019 Feb 26;55(3):58. doi: 10.3390/medicina55030058.
Remained or forgotten ureteral double-J stents may cause serious complications. Removing of an encrusted, forgotten stent can be challenging. We present our experience with heavily encrusted ureteral stents and discuss the endourologic treatment options as well as their effectivity. Eleven men and six women (mean 48.58 ± 14.48 years of age) with 18 encrusted forgotten stents (mean 16.4 ± 13.25 months of indwelling) were treated at our clinic. All patients underwent the operation after negative urine cultures were obtained. Their medical records were retrospectively reviewed and analyzed in terms of number of interventions required to remove the stent, operation time, complications, hospital stay and stone-free rate. According to the Forgotten-Encrusted-Calcified (FECal) classification, the most common form of stent encrustation was grade III (64.7%) and 17.6% of the stents were fragmented. Four of 17 patients were initially treated with extracorporeal shock-wave lithotripsy. The patients required a mean of two endoscopic interventions for removing the encrusted stent and all stents were removed endoscopically in a single session. The mean operating time was 63.3 ± 41.8 minutes. Cystolithotripsy followed by ureteroscopy was the most common intervention (41.1%). Of the 17 patients, peroperative and postoperative complications were Clavien grade I in two, grade II in two and grade IIIb in one. The mean hospital stay was 1.3 ± 0.99 days. All patients were stone-free after a month of stent removal. The endourological removal of the encrusted forgotten stents in a single session is feasible and effective with a minimal morbidity. The treatment strategy should be to minimize the number of interventions.
残留或遗忘的输尿管双J支架可能会导致严重并发症。取出结壳、被遗忘的支架具有挑战性。我们介绍了我们处理严重结壳输尿管支架的经验，并讨论了腔内泌尿外科治疗方案及其有效性。我们诊所治疗了11名男性和6名女性（平均年龄48.58±14.48岁），他们共有18个结壳、被遗忘的支架（平均留置时间16.4±13.25个月）。所有患者在尿培养阴性后接受手术。对他们的病历进行回顾性审查，并分析取出支架所需的干预次数、手术时间、并发症、住院时间和无结石率。根据遗忘-结壳-钙化（FECal）分类，支架结壳最常见的形式为III级（64.7%），17.6%的支架发生断裂。17名患者中有4名最初接受了体外冲击波碎石术。患者平均需要两次内镜干预来取出结壳的支架，所有支架均在一次内镜手术中取出。平均手术时间为63.3±41.8分钟。膀胱碎石术联合输尿管镜检查是最常见的干预方式（41.1%）。17名患者中，围手术期和术后并发症Clavien I级2例，II级2例，IIIb级1例。平均住院时间为1.3±0.99天。所有患者在取出支架一个月后均无结石。单次腔内泌尿外科手术取出结壳、被遗忘的支架是可行且有效的，并发症发生率极低。治疗策略应是尽量减少干预次数。
