Single-sitting endourological management of retained ureteral stents at Groote Schuur Hospital: a four-year retrospective study

Abstract

Introduction: Double-J stents have become essential for endourological and open urological procedures. Removing severely encrusted and retained ureteral stents poses a management challenge for urologists, as multiple procedures are often required to remove them.

Objectives: The main objective is determining the proportion of patients with retained stents who can be rendered stent-free with single-sitting endourological management. Other objectives are to describe the number of procedures required to render patients with retained stents stone- and stent-free and to describe the demographical and clinical variables of patients with retained ureteral stents at Groote Schuur Hospital (GSH).

Materials and methods: A retrospective study was conducted between 1 February 2018 and 31 January 2022. The files of 30 patients who met the inclusion criteria with retained and encrusted stents were reviewed. All patients were initially evaluated with radiographic imaging to assess stone burden. Treatment decisions were based on the FECal (forgotten-encrusted-calcified) classification of retained stents. Multimodal endourological procedures were performed to render the patients stone- and stent-free.

Results: The average age of the participants was 39.4 years, while the male participants were the most common (66%; n = 19). A total of 87 urological procedures were performed to render all 30 patients stone- and stent-free. The average duration of stent indwelling time was 20.35 months, with a range of 4–70 months. The main indication for stent placement was stone obstruction (55.56%). Of the patients, 41% (n = 12) had percutaneous nephrolithotomy (PCNL), while 48% (n = 14) received ureteroscopy and laser lithotripsy. The most common FECal classification was IV at 59% (n = 17). Stent encrustation most commonly affected the right side (55.56%).

Conclusion: The endoscopic combined approach is a safe and feasible technique that removes retained and encrusted stents in a single procedure.