Introduction and Objectives
The management of calcified or migrated ureteral stents may be a complex and difficult task. This study aimed to evaluate the efficacy of the endoscopic treatment in these cases.
Material and Methods
Between January 2000 and January 2009, we treated 67 patients with calcified stents (Group I) and 58 patients with migrated ureteral stents (Group II). Group I consisted of 34 cases with inferior loop calcification, 13 cases with superior loop calcification, 9 cases with both inferior and superior loop calcification, 8 cases with calcification of the ureteral segment, 3 cases with calcification of the entire stent length. The average stenting time was 14.6 months (range 3–36 months). Group II consisted in 52 cases with the distal loop ascended into the ureter and 6 cases with the stents completely migrated into the pyelocaliceal system.
In Group I, we performed vesical ballistic lithotripsy (34 cases, 100% success), percutaneous nephrolithotomy (13 cases, 92.3% success), vesical ballistic lithotripsy and percutaneous nephrolithotomy (9 cases, 100% success), ureteroscopic lithotripsy (8 cases, 87.5% success), vesical ballistic lithotripsy, ureteroscopy and percutaneous nephrolithotomy (3 cases, 100% success). In Group II, we performed retrograde ureteroscopic extraction in 57 cases. In one case with a stent ascended superjacent to a neoplastic extrinsic ureteral stenosis, impassable in a retrograde fashion, we performed minipercutaneous stent's extraction using a semirigid ureteroscope antegradely inserted.
Calcified or migrated stents may be successfully managed using endoscopic techniques. Combined retrograde and antegrade endourological approach is often necessary, sometimes requiring advanced endoscopic skills.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.