| |
Approaches to the Retained Stent
Back to 77th Annual Meeting
Back to Program Outline
Approaches to the Retained Stent
Micah Jacobs, M.D., Robert A. Roth, M.D..
Lahey Clinic, Burlington, MA, USA.
Background:
A retained ureteral stent is one that cannot be removed by usual cystoscopic methods. Most retained stents are caused by upward migration beyond the ureteral orifice, stone encrustation or stent breakage. We describe our experience with retained stents and suggest various methods for successful removal.
Methods:
Between June 2005 and January 2008, 9 patients were treated for 12 retained stents. 1 migrated and 11 encrusted stents were treated. Encrusted stents can have stones on the bladder, ureteral, or renal pelvic sections or combinations thereof. Depending on stone location, they were removed by ureteroscopy and laser lithotripsy or SWL. Laser lithotripsy was performed using the holmium YAG laser along the axis of the stent with care to avoid damage to the stent. The migrated stent was removed by percutaneous access.
Technique: A guidewire should be passed alongside the stent into the renal pelvis. It is then helpful to externalize the distal coil in females. A Kelley clamp is then snapped onto this end for gentle weighted countertraction. A 7 F. semirigid ureteroscope can then be passed alongside the wire and stent to utilize the laser. Often, it can be passed up into the renal pelvis to break up stones on the proximal coil. If this is not possible, a 7 F flexible ureteroscope can be passed over the wire and alongside the stent. A 9 F access sheath may facilitate passage of the flexible ureteroscope.
Results:
A total of 12 retained stents were treated. Of the 11 encrusted stents 2 were removed cystoscopically after shockwave lithotripsy. One stent had to be removed percutaneously after shockwave lithtripsy and ureteroscopic approaches failed. The remaining 8 encrusted stents were removed after ureteroscopic laser lithotripsy.
Conclusions:
Retained stents represent a difficult challenge. We have found that most stents can be approached reliably with ureteroscopy and laser lithotripsy. This may be due to the ureteral dilatation that occurs around encrusted stents which allows passage of a ureteroscope with surprising ease. For those stents unable to be removed in this way, SWL or percutaneous access may be necessary.
Back to 77th Annual Meeting
Back to Program Outline
|
|
