To propose and evaluate a new endoscopic technique using only a retrograde ureteroscopic approach for the removal of heavily encrusted ureteral stents.
Data from 51 consecutive patients with encrusted and retained ureteral stents were prospectively collected. Description of the successive steps of surgery is detailed. The Holmium-YAG laser properties offer the opportunity for fragmentation of stent-attached encrustation and the ability to cut the stent itself. Reducing the length of the stent is critical to creating space in the ureter and to allow free access for ureteroscopes or ureteral access sheath placement. The primary outcome of this study was the feasibility and the safety of this retrograde intra-renal approach. Some factors of encrustation and outcomes are also discussed in comparison with lithotripsy, percutaneous, laparoscopic, open surgery or a combination of these techniques.
The removal of the encrusted stent was possible with only this retrograde technique in 98% of patients. The transection of the encrusted stent with the Holmium-YAG laser was useful in 71% of the patients. Mean operative time was 110 minutes and mean hospital stay was 2.33 days. Postoperative complications were mainly non-obstructive pyelonephritis (10%). The most significant predictor of this life threatened complication was the presence of struvite stones with the encrusted stent (p=0,018). Contrariwise, operative time, BMI, gender and encrustation rate were not associated with postoperative pyelonephritis. Cystine stone disease or pregnancy both led to faster stent encrustation.
Retrograde ureteroscopic surgery is efficient and safe for removing retained stents and associated stone burdens. The Holmium-YAG laser is essential to perform the encrustation removal and sectioning of the stent.
Journal of endourology. 2017 Mar 14 [Epub ahead of print]
Alexandre Thomas, Jonathan Cloutier, Luca Villa, Julien Letendre, Achilles Ploumidis, Olivier Traxer
CHU Liege, Urology , Avenue de l'hopital B35 , LIEGE, Belgium , 4000., University Hospital Centre of Quebec City, Urology , 10 rue de l'Espinay , Quebec, Quebec, Canada , G1L3L2 ; ., Università Vita-Salute San Raffaele, Urology , Via Olgettina, 60 , Milan, Italy , 20132 ; ., Maisonneuve-Rosemont Hospital, Urology , 5345 Blvd De L'Assomption , Bureau 220 , Montreal, Quebec, Canada , H1T 4B3 ; ., Athens, Greece ; ., Tenon Hospital, Assitance Publique-Hopitaux De Paris. Pierre Et Marie Curie University, Paris 6, Urology , 4 rue de la Chine , Paris, France , 75020 ; .