Extracorporeal shock wave lithotripsy in the primary treatment of encrusted ureteral stents

Abstract

Double pigtail (JJ) ureteral stents, are the most commonly used method of urinary diversion in the ureteral obstructions. Encrustations may occur as a result of prolonged exposure due to forgetting these stents in the body. Removing these materials might be an annoyance. Forty-four patients from three tertiary referral centres with forgotten JJ stents left in them between the years 2007 and 2014 were included in the study. Stents could not be removed by attempted cystoscopy. As an alternative approach, extracorporeal shock wave lithotripsy (ESWL) was the first choice since it is minimally invasive. The results of that treatment are presented along with the relevant demographic data. JJ stenting for urolithiasis was performed in 36 patients, after open surgery in five patients, and for oncological reasons in three patients. ESWL was applied to stents or to any suspicious region adjacent to the stent. In 29 of 44 patients, the stents were easily removed under cystoscopic procedures while in one patient the fragmented residual stent was spontaneously excreted. In eight patients, ureteroscopy was required; in five patients, percutaneous nephrolithotripsy was required; and in one patient, open surgery was required in order to remove stents. ESWL can be considered as a first-line treatment when a forgotten JJ stent is detected despite all precautions after any kind of urological intervention involving insertion of ureteral stents.