Effectiveness of Holmium Laser Lithotripsy Treatment on Forgotten Double-J Stents With Encrustations

Yıl 2017, Cilt: 9 Sayı: 4, 250 - 258, 01.12.2017

Engin Kölükçü Bekir Süha Parlaktaş Şahin Kılıç Fikret Erdemir Yahya Doğanay

Öz

Aim: In our study, we aimed to present the results
of ureterorenoscopic holmium laser lithotripsy treatment on 14 forgoten
double-j stents with encrustations.

Material and Methods: The data of 14 patients who
underwent holmium laser lithotripsy treatment for forgotten D-J stent
encrustations between January 2015 and May 2017 were reviewed retrospectively.
The patients' age, symptoms, length of stay of ureteral stents, size of encrustations,
locations, duration of operation and complications according to modified Clavien
classification were evaluated.

Results: The mean age of the patients was 59.41 ± 5.23
years. 2 patients admitted to our clinic with lower urinary tract complaints
such as frequent urination, urinary incontinence, 5 patients admitted with side
pain, 3 patients admitted with hematuria, 1 patient admitted with hematuria and
side pain, 1 patient admitted with urinary tract infection and 2 patients
admitted with lower urinary tract complaints and hematuria. The mean length of
stay of stents was 20.5 ± 6.11 months. The mean size of the encrustations was
311±43 mm². Operation complications were evaluated according to
modified Clavien classification. Proximal stent encrustation was observed in 3
patients and distal in 11 patients. The mean duration of operation was
calculated as 63.12 ± 9.48 minutes. Complications were observed in 1.level in 2
patient, 2. level in 1 patient and 3a level in 1 patient.

Conclusion: According to the results
obtained in our study; the use of ureterorenoscopic holmium laser lithotripsy
is an effective and reliable method for the treatment of forgotten double-J
stents with encrustations.

Anahtar Kelimeler

Double-J stent, encrustations, holmium laser lithotripsy

Unutulan Double-J Stentlere Bağlı Gelişen Stent Enkrustasyonlarının Tedavisinde Holmium Lazer Litotripsinin Etkinliği

Öz

Amaç: Çalışmamızda unutulan D-J
stentlere bağlı gelişen stent enkrustasyonu tespit edilen 14 hastaya
uyguladığımız üreterorenoskopik holmiyum lazer litotripsi sonuçlarını sunmayı
hedefledik.

Gereç ve Yöntem: Ocak
2015-Mayıs 2017 yılları arasında unutulan D-J stent enkrustasyonu nedeniyle
holmiyumlazer litotripsi uygulunan 14 hastanın verileri retrospektif olarak
incelendi. Çalışmaya alınan hastaların yaşı, hastaneye başvuru şikayetleri,
üreteral stentlerin kalış süreleri, enkrustasyon boyutu, yerleşimi, operasyon
süreleri ve modifiye Clavien sınıflamasına göre komplikasyonları
değerlendirildi.

Bulgular: Hastaların
ortalama yaşı 59.41±5.23 yıl idi. 3 hasta idrarda kanama, 2 hasta sık idrara
çıkma ve urge inkontinans gibi alt üriner sistem yakınması ile, 5 hasta yan
ağrısı, 1 hasta idrarda kanama ile birlikte olan yan ağrısı, 1 hasta idrar yolu
enfeksiyonu ve 2 hasta ise idrarda kanama ile birlikte olan alt üriner sistem
yakınması ile kliniğimize başvurdu.Stentlerin ortalama kalış süreleri 20.5±6.11
aydı. Ortalama enkrustasyon boyutu 311±43 mm² idi.Hastaların 11’inde
distal ve 3’ünde ise proksimal stent enkrustasyonu izlendi. Ortalama operasyon
süresi 63.12±9.48   dakika olarak
hesaplandı. Modifiye Clavien sınıflamasına göre operasyon komplikasyonları
değerlendirildi.2 hastada 1. düzeyde, 1 hastada 2. düzeyde ve 1 hastada ise 3a
düzeyinde komplikasyon izlendi.

Sonuç: Çalışmamızda elde edilen
verilere göre; unutulan üreteral stentlere bağlı oluşan stent enkrustasyonlarının
tedavisinde üreterorenoskopik holmiyum lazer litotripsi kulanımının etkin ve
güvenilir bir yöntem olduğu sonucuna varılmıştır.

Anahtar Kelimeler

Double-J stent, enkrustasyon, holmiyum lazer litotripsi

Kaynakça

• 1. Monga M, Klein E, Castaneda-Zuniga WR, Thomas R. The forgotten indwelling ureteral stent: a urological dilemma. J Urol. 1995;153:1817-1819.
• 2. Özcan L, İlbey YÖ, Özbek E, Önal ŞY, Şimşek A, Köse O. Unutulan double J stente bağlı gelişen ilginç bir taş oluşumu: olgu sunumu ve literatürün gözden geçirilmesi. Kartal Eğitim ve Araştırma Dergisi. 2008;19(2): 85-89.
• 3. 3.Singh I, Grupta NP, Hemal AK, Aron M,Seth A, Dogra PN. Severely encrustedpolyurethane ureteral stents. Managementand analysis of potential risk factors.Urology. 2001;58(4):526-531.
• 4. Yeh CC, Chen CH, Lin CH, Chang CH, Wu HC. A new technique for treating forgotten indwelling ureteral stents: silk loop assisted ureterorenoscopic lithotripsy. J Urol. 2004;171:719-721.
• 5. Flan T, Brochard M, Zerbib M, Debre B, Steg A. Extracorporeal shock wave lithotripsy to remove calcified ureteral stents. Urology. 1990;36:164-165.
• 6. Ather MH, Talati J, Biyabani R. Physician responsibility for removal of implants: The case for a computerized program for tracking overdue double-J stents. Tech Urol. 2000;6:189-192.
• 7. Kadıoğlu TC, Tefekli A, Esen T, Tunç M. DJ üreteral stentlerin mekanik komplikasyonları ve üreterorenoskopi uygulaması. Türk Üroloji Dergisi. 1998;24:159-163.
• 8. Prodromos GB, Christopher JK. Current management of severely encrusted ureteral stents with a large associated stone burden. J Urol. 2000; 164:648-650.
• 9. Weedin J, Coburn M, Link R The impact of proximal stone burden on the management of encrusted and retained ureteral stents. The Journal of Urology. 2011;185(2):542-547.
• 10. Richter S, Ringel A, Shalev M, Nissenkom I. The indwelling ureteric stent: a 'friendly' procedure with unfriendly high morbidity. BJU Int. 2000;85:408-411.
• 11. KibarY,Akay O,Erdemir F, Dayanç M. Unutulmuş üreteral çift J stentin piyelolitotomi ile çıkartılması Gülhane Tıp Dergisi. 2005;47:218-220.
• 12. Witjes JA. Breakage of a silicone double pigtail ureteral stent as a long-term complication. J Urol. 1993;150:1898-99.
• 13. Canby-Hagino ED, Caballero RD, Harmon WJ. Intraluminal pneumatic lithotripsy for the removal of encrusted urinary catheters. J Urol. 1999;162:2058- 2060.
• 14. Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967;97(5):840-844.
• 15. Finney RP. Experience with new double J ureteral catheter stent. J Urol. 1978;120:678-681.
• 16. Murthy KV, Reddy SJ, Prasad DV. Endourological Management of Forgetten Encrusted Ureteral Stents. Int Braz J Urol. 2010;36 (4):420-429.
• 17. Saltzman B. Ureteral stents. Indıcations, variations and complications. Urol Clin North Am. 1988;15:481-491.
• 18. Soylu A, Altunoluk B, Güneş A, Baydinç YC. Unutulmuş üreteral stente bağlı böbrek kaybı. Türk Üroloji Dergisi. 2004;30:245-248.
• 19. Persky L, Lockhart JJ, Karp R, Helal M, Hakki D The overlooked, retained Double J stent. Urology. 1990;36:519.
• 20. Haleblian, G, Kijvikai K, Rosette J, Preminger G Ureteral stenting and urinary stone management: a systematic review. J Urol. 2008;179:424.
• 21. Kehinde EO, Al-Awadi KA, Tawheed A, Al-Hunayan A, Ali Y, Mahmoud AH. : Factors affecting the fate of prolonged forgotten ‘J’ stents. Scand J Urol Nephrol. 2001;35(3):222-227.
• 22. Seymour H, Patel U. Ureteric stenting: Current status. Semin Intervent Radiol. 2000;17:351-365.
• 23. Lange D, Bidnur S, Hoag N, Chew BH. Ureteral stent-associated complications--where we are and where we are going. Nat Rev Urol. 2015;12:17-25.
• 24. Damiano R, Oliva A, Esposito C, De Sio M, Autorino R, D'Armiento M. Early and late complications of double pigtail ureteral stent. Urol Int. 2002;69:136-40.
• 25. Polland SG, MacFarlane R. Symptoms arising from double j ureteral stents. J Urol. 1988;139:37-38.
• 26. El-Faqih SR, Shamsuddin AB, Chakrabarti A, Atassi R, Kardar AH, Osman MK, Husain I: Polyurethane internal ureteral stents in treatment of stone patients: Morbidity related to indwelling times. J Urol.1991;146:1487-1491
• 27. Ringel A, Richter S, Shalev M, Nissenkorn I: Late complications of ureteral stents. Eur Urol. 38:41-44, 2000.
• 28. Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX Jr, Timoney AG: Indwelling ureteral stents: evaluation of symptoms, quality of life and utility.J Urol. 2003;169(3):1065-1069.
• 29. Somers W. Management of forgotten retained indwelling üreteral stents. Urology. 1996;47:431-435.