Management of encrusted ureteral stents impacted in upper tract.

ABSTRACT

OBJECTIVES: To present our series of patients with ureteral stent encrustation and give indwelling times and management. Encrustation is one of the most serious complications of ureteral stents. METHODS: A retrospective review was undertaken of all encrusted stents during a 4-year period. The inclusion criterion was a stent that required some form of intervention above the ureteral orifice to remove it. Combinations of extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery were used to achieve stent removal. RESULTS: Forty-nine impacted encrusted stents were treated in 41 patients. Of these, 75.5% had become encrusted within 6 months and 42.8% within 4 months. The mean indwelling time was 5.6 months. Forty-seven stents were removed by endourologic techniques, with 4 requiring extracorporeal shock wave lithotripsy alone, 28 ureteroscopy, and 10 a combination of both. Five patients underwent successful percutaneous nephrolithotomy. One patient underwent open surgery, and in one removal failed. The mean number of procedures per patient was 1.94. CONCLUSIONS: Stent encrustation can pose a serious challenge to the endourologist, and indwelling times should be minimized to avoid problems. Patients often require multiple treatments and a combination of extracorporeal shock wave lithotripsy and ureteroscopy offers highly successful outcomes and often avoids the need for more invasive techniques.