Management of Forgotten Ureteral Stents: Relationship Between Indwelling Time and Required Treatment Approaches

Abstract

Background: Double-J stents are widely used in urology practice, and removal of these stents can sometimes be forgotten. Aims: To investigate whether indwelling time of double-J stent can predict which treatment modality is required for removal of the stent from the body. Study Design: A multicentre, retrospective observational study. Methods: The data of 57 patients who were treated for forgotten ureteral stents between January 2007 and December 2014 were evaluated retrospectively. Patients were classified into four groups according to indwelling time of the stents: 6-12 months, 13-24 months, 25-36 months, and >36 months. Encrustation and associated stone burden of the stents were evaluated with non-contrast stone protocol computerised tomography. Results: Patients were classified according to their duration of the stent indwelling time. Simple cystoscopic stent retrieval was performed in 71.4% of patients in the 6-12 months group, 44% of patients in the 13-24 months group, 6.2% of patients in the 25-36 months group, and 11.1% of patients in the >36 months group. A percutaneous or open surgery was required in no patients with an indwelling time of double-J stent shorter than 30 months. Conclusion: Transurethral and/or percutaneous combined endo-urological approaches are usually sufficient for the removal of forgotten double-J stents. Transurethral procedures are sufficient for the treatment of patients with double-J stent indwelling times less than 30 months.

Keywords

• Disease management, foreign bodies, urinary catheters, urolithiasis

Kaynakça

1. 1. Rabani SM. Combined percutaneous and transurethral lithotripsy for forgotten ureteral stents with giant encrustation. Nephrourol Mon 2012;4:633-5.
2. 2. el-Faqih SR, Shamsuddin AB, Chakrabarti A, Atassi R, Kardar AH, Osman MK, et al. Polyurethane internal ureteral stents in treatment of stone patients: morbidity related to indwelling times. J Urol 1991;146:1487-91.
3. 3. Rana AM, Sabooh A. Management strategies and results for severely encrusted retained ureteral stents. J Endourol 2007;21:628-32.
4. 4. Sancaktutar AA, Adanur Ş, Reşorlu B, Tepeler A, Ziypak T, Söylemez H, et al. The forgotten ureteral stent in children: from diagnosis to treatment. J Urol 2013;189:1054-60.
5. 5. Singh V, Srinivastava A, Kapoor R, Kumar A. Can the complicated forgotten indwelling ureteric stents be lethal? Int Urol Nephrol 2005;37:541-6.
6. 6. Pühse G, Piechota H, Scheffold C, Kloska S, Hertle L, Wülfing C. Multiorgan failure 17 years after initial stone therapy: forgotten ureteral stent in a horseshoe kidney. Eur Urol 2007;52:1784-7.
7. 7. Wollin TA, Tieszer C, Riddell JV, Denstedt JD, Reid G. Bacterial biofilm formation, encrustation, and antibiotic adsorption to ureteral stents indwelling in humans. J Endourol 1998;12:101-11.
8. 8. Robert M, Boularan AM, El Sandid M, Grasset D. Double-J ureteric stent encrustations: clinical study on crystal formation on polyurethane stents. Urol Int 1997;58:100-4.

9. 9. Keane PF, Bonner MC, Johnston SR, Zafar A, Gorman SP. Characterization of biofilm and encrustation on ureteric stents in vivo. Br J Urol 1994;73:687- 91.
10. 10. Finney RP. Double-J and diversion stents. Urol Clin North Am 1982;9:89- 94.
11. 11. Persky L, Lockhart JJ, Karp R, Helal M, Hakki S. The overlooked, retained Double J stent. Urology 1990;36:519-21.
12. 12. Weedin JW, Coburn M, Link RE. The impact of proximal stone burden on the management of encrusted and retained ureteral stents. J Urol 2011;185:542-7.
13. 13. Karalezli G, Gögüş O, Bedük Y, Köküuslu C, Sarica K, Kutsal O. Histopathologic effects of extracorporeal shock wave lithotripsy on rabbit kidney. Urol Res 1993;21:67-70.
14. 14. Sancaktutar AA, Söylemez H, Bozkurt Y, Penbegül N, Atar M. Treatment of forgotten ureteral stents: how much does it really cost? A cost-effectiveness study in 27 patients. Urol Res 2012;40:317-25.