Successful Endoscopic Management of a Neglected and Encrusted Ureteral Stent with Giant Cystolithiasis and Nephrolithiasis Using Ho-YAG Laser Lithotripsy

Abstract

Encrusted and neglected ureteral stents pose therapeutic challenges to the urologist. Most of these patients are require to open surgery to extract the stent with stones in the renal and bladder segments. The authors present their experience with successful endoscopic management of this clinical problem. A 61 year-old male, who had PCNL for left staghorn calculus a year ago failed to follow-up for stent removal. CT scan showed a giant cystolithiasis and nephrolithiasis enveloping the ends of the stent. Successful laser cystolithotripsy was performed followed by a percutaneous nephrolithotripsy and antegrade stent removal two days later.

The operative time for the cystolithotripsy and PCNL were 180 and 200 mins. respectively. There were no intraoperative complications. The patient required prolonged intravenous antibiotic therapy and was discharged in good condition on postoperative day 5 with any serious complications. Neglected, forgotten stents can be managed safely and effectively with endourologic techniques, offering the advantages of less pain, faster recovery and better cosmetic outcome.