ENDOUROLOGY & LAPAROSCOPY

A new technique for treating forgotten indwelling ureteral stents: silk loop assisted ureterorenoscopic lithotripsy
Yeh C-C, Chen C-H, Lin C-H, Chang C-H, Wu H-C
From the Department of Urology, China Medical University Hospital, China Medical University, Taichung City, Taiwan, Republic of China
J Urol. 2004; 171:719-21

• Purpose: Treating forgotten indwelling ureteral stents is difficult because forgotten stents become encrusted and fragmented. Therefore, we developed a silk loop with which to loop the lower end of a forgotten ureteral stent during ureterorenoscopy to supply a counterforce, which fixed the stent while separating encrusted stones from the forgotten stent. We evaluated the success of the silk loop method.
• Materials and Methods: Nine patients were enrolled in this study from 1997 to 2003. Each patient had a forgotten ureteral stent with renal stones on the tip of the proximal end. All consented to the procedure of silk loop assisted ureterorenoscopic lithotripsy (URSL) with a Lithoclast (Microvasive, Natick, Massachusetts) lithotriptor.
• Results: We successfully removed the forgotten indwelling stent from all 9 patients with the silk loop assisted URSL method.
• Conclusions: Silk loop assisted URSL makes the removal of forgotten stents easier. While percutaneous nephrostolithotomy and open surgery produce successful results, the silk loop method is less invasive and expensive, and it minimizes hospital recovery time.
  
  
• Editorial Comment
  Encrusted retained ureteral stents are a frustrating and difficult surgical challenge. Shock wave lithotripsy of the stent to loosen fragments, combined percutaneous and cystoscopic lithotripsy of the renal and bladder ends of the stent (which are usually the most encrusted), and open surgery have all been reported. The authors of this article demonstrate nicely that small caliber ureteroscopes can be used with great effectiveness to provide a less morbid, outpatient solution. The silk-loop retraction of the bladder end of the stent appears to be a great trick, as friction of the ureteroscope on the stent can sometimes be problematic as the ureteroscope is advanced up the ureter, and allowed use of a semi-rigid instrument with a pneumatic lithotrite. The next time you are faced with an encrusted ureteral stent, consider the ureteroscopic approach.

Dr. J. Stuart Wolf Jr.
Associate Professor of Urology
University of Michigan
Ann Arbor, Michigan, USA