University of Health Sciences, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul /Turkey.
Urol J. 2020 May 16;17(3):248-251. doi: 10.22037/uj.v0i0.5516.
To report our single-center experience in encrusted ureteral stent management and to compare the utility of two different scoring systems, KUB (Kidney, Ureter, Bladder) versus FECal (forgotten, encrusted, calcified), in patient management.
We retrospectively analyzed the medical records of all patients who were found to have encrusted/retained ureteral stent and underwent various procedures to remove encrusted ureteral stent in our clinic between May 2014 and December 2018. Encrusted stent grading was performed using KUB and FECal grading systems. KUB system score is the sum of the stone burden scores of 3 different parts of an encrusted stent within the kidney, ureter and bladder determined using a scale from 1 to 5 according to the maximal diameter of encrustation. FECal grading system is based on the stone size, location and degree of stent encrustation and scored from Grade 1 to Grade 5.
A total of 39 patients (29 males and 10 females) were included the study. The mean age of the patients was 46.4 ± 14.5 years, ranging from 13 to 71 years. The mean time from ureteral stent insertion to encrustation was 13.7 ± 26.4 months, varying between 2 and 120 months. The mean KUB score was 6.4 ± 2.4. According to FECal system, 53.8% of the patients were classified as Grade 1 and 15.4% as Grade 2. The encrusted ureteral stents of eight patients (20.5%) could be removed with the aid of a foreign body forceps inserted through a cystoscope. Fourteen patients (35.9%) underwent cystolithotripsy, seven (17.9%) underwent flexible ureterorenoscopy (URS), six (15.4%) underwent rigid URS, and three (7.7%) underwent combined percutaneous nephrolithotomy and URS beside stent removal. In multivariate regression analysis, largest encrustation diameter, FECal system grade and KUB score were found to be significant predictors of stone- and stent-free status (p<0.001 for all). Also, KUB score was found to be associated with the number of required procedures (r= .506, p= .001).
KUB encrusted stent scoring system might be useful in predicting the number of required procedures to achieve stone- and stent-free status. Pure intracorporeal endourologic procedures, percutaneous interventions or open surgery might be preferred according to the patient's situation and the surgeon's experience and preference.
报告我们在有钙化/包裹的输尿管支架管理方面的单中心经验，并比较两种不同的评分系统（KUB（肾脏、输尿管、膀胱）与 FECal（遗忘、包裹、钙化））在患者管理中的应用。
我们回顾性分析了 2014 年 5 月至 2018 年 12 月期间在我院发现有钙化/包裹的输尿管支架并接受各种方法清除钙化/包裹的输尿管支架的所有患者的病历。采用 KUB 和 FECal 评分系统对钙化/包裹的输尿管支架进行分级。KUB 系统评分是根据钙化/包裹的最大直径，对肾、输尿管和膀胱内 3 个不同部位的支架的结石负担进行评分，范围为 1 到 5 分。FECal 分级系统基于结石大小、位置和支架包裹程度，从 1 级到 5 级进行评分。
共纳入 39 名患者（29 名男性和 10 名女性）。患者的平均年龄为 46.4±14.5 岁，年龄范围为 13 至 71 岁。从输尿管支架置入到钙化/包裹的平均时间为 13.7±26.4 个月，时间范围为 2 至 120 个月。KUB 评分平均为 6.4±2.4。根据 FECal 系统，53.8%的患者为 1 级，15.4%为 2 级。在 8 名患者（20.5%）中，可通过膀胱镜插入异物钳取出钙化/包裹的输尿管支架。14 名患者（35.9%）接受了膀胱碎石术，7 名患者（17.9%）接受了软性输尿管镜检查（URS），6 名患者（15.4%）接受了硬性 URS，3 名患者（7.7%）接受了经皮肾镜取石术联合 URS 以清除支架。在多变量回归分析中，最大钙化/包裹直径、FECal 系统分级和 KUB 评分被发现是结石和支架清除状态的显著预测因子（p<0.001）。此外，KUB 评分与所需手术次数相关（r=.506，p=.001）。
KUB 钙化/包裹支架评分系统可能有助于预测实现结石和支架清除状态所需的手术次数。根据患者情况和外科医生的经验和偏好，可以选择纯腔内腔内泌尿外科手术、经皮介入或开放手术。
