Bilateral Encrusted Metallic Stent Successfully Removed by Ureteroscopic Lithotripsy Using a Ho:YAG Laser in a Patient with Malignant Myeloma

Ureteral stent encrustation is sometimes encountered, especially in cases in which a ureteral stent has been forgotten. An 84-year-old female patient with malignant myeloma underwent metallic ureteral stent insertion to treat malignant ureteral obstruction. At the time of scheduled ureteral stent exchange, the stent was heavily encrusted and could not be removed on either side. We performed endoscopic lithotripsy to remove the encrusted ureteral stents. The bilaterally encrusted metallic ureteral stents were successfully removed using Ho:YAG laser lithotripsy after inserting another ureteral stent placement besides the encrusted metallic ureteral stents.

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Comparative Study Between Holmium Laser versus Pneumatic Ureteroscopic Lithotripsy for Proximal Ureteric Stones Close to Pelvi-ureteric Junction (PUJ) -A Prospective Trial

Bangladesh Journal of Urology ◽

10.3329/bju.v23i2.50313 ◽

2020 ◽

Vol 23 (2) ◽

pp. 188-192

Author(s):

Harun Or Rashid ◽

Md Shahidul Islam ◽

SM Shameem Waheed ◽

Md Abdur Rakib ◽

Md Ashif Chowdhury ◽

...

Keyword(s):

Laser Lithotripsy ◽

Stent Insertion ◽

Stone Size ◽

Ureteroscopic Lithotripsy ◽

Secondary Intervention ◽

Upward Migration ◽

Ho:Yag Laser ◽

Double J Stent ◽

Stone Free Rate ◽

Free Rate

Objective: To compare the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter versus Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper ureteric stones. Materials and methods: Patients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper ureteric stones were reviewed. Patients with urinary tract infection, ,loss of follow-up, concurrent middle or lower third ureteral stones or acute renall failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups. Results: There were 70 patients with upper ureteric stones (35 in pneumatic group and 35 in laser group) meeting the study criteria. Patients’ age, gender, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less upward migration and secondary intervention rate, sepsis as compared with pneumatic lithotripsy (94.2% vs. 60%; 85% vs. 100%; 5.7% vs 40%; 5.7% vs 34.2%; 2.8 vs 2.8 respectively, all p < 0.05). In patients with stones sizes 8-10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate. Conclusions: Ho:YAG laser lithotripsy is better and much effective than pneumatic lithotripsy in the management of upper ureteric stones in terms of, stone free rate and secondary intervention rate for stones of sizes about 8 to 10 mm.Although the access of upper ureter is difficult but our small calibre (4.5 fr) ureteoscope and gentle manuevre have made the procedures safe and successful. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.188-192

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The resonance® metallic ureteral stent in the treatment of malignant ureteral obstruction: a prospective observational study

BMC Urology ◽

10.1186/s12894-019-0569-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Jun Miyazaki ◽

Mizuki Onozawa ◽

Satoshi Takahashi ◽

Yuka Maekawa ◽

Mitsuru Yasuda ◽

...

Keyword(s):

Ureteral Obstruction ◽

Ureteral Stent ◽

Stent Insertion ◽

Ureteral Stricture ◽

Metallic Stent ◽

Ureteric Stenting ◽

Malignant Ureteral Obstruction ◽

Ureteral Stenting ◽

The Difference

Abstract Background To study the outcomes and experiences of using metallic stents in treating patients with malignant ureteral obstruction (MUO), we examined the effects of metallic ureteral stenting using the Cook Resonance® stent in the treatment of MUO. Methods All patients who had a Resonance metallic stent inserted between April 2015 and March 2018 at one of multiple facilities were prospectively observed with a 1-year follow-up. The primary outcome was the patency rate of the metallic ureteral stent. The secondary outcomes included the complications (e.g., infection and fever). Results Although stent insertion was attempted in 50 patients, the stent could not be inserted as a ureteral stent in three patients due to severe ureteral stricture, and one ureteral cancer patient was excluded from the analysis. The remaining 46 patients’ median age was 67 years (range 28–85 years) (16 males, 30 females). Twenty-four patients died during the study; their median survival time was 226 days. The median follow-up period for the censored patients was 355 days (range 16–372 days), and just seven patients were still alive without Resonance failure > 1 year later. The women’s IPSS scores tended to be lower than those of the men. Regarding the OABSS score, although the women’s total score tended to be low, the difference between the men’s and women’s scores was nonsignificant. The bacteria detected from urine culture after stent insertion were more gram-positive than gram-negative. Conclusion Metallic ureteric stenting using the Resonance stent is safe and effective for treating MUO. Subjective symptoms were relatively less in the female patients.

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Impact of loop-tail ureteral stents on ureteral stent-related symptoms immediately after ureteroscopic lithotripsy: Comparison with pigtail ureteral stents

Investigative and Clinical Urology ◽

10.4111/icu.2017.58.6.440 ◽

2017 ◽

Vol 58 (6) ◽

pp. 440 ◽

Cited By ~ 6

Author(s):

Makoto Taguchi ◽

Takaaki Inoue ◽

Kouei Muguruma ◽

Takashi Murota ◽

Hidefumi Kinoshita ◽

...

Keyword(s):

Ureteral Stent ◽

Ureteral Stents ◽

Ureteroscopic Lithotripsy

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Successful removal of an encrusted metallic ureteral stent using a disposable ureteroscope and Ho:YAG laser lithotripsy

Urolithiasis ◽

10.1007/s00240-019-01171-9 ◽

2019 ◽

Vol 48 (3) ◽

pp. 281-282 ◽

Cited By ~ 1

Author(s):

Takashi Kawahara ◽

Kota Kobayashi ◽

Shinnosuke Kurora ◽

Masahiro Yao ◽

Hiroji Uemura

Keyword(s):

Laser Lithotripsy ◽

Ureteral Stent ◽

Ho:Yag Laser ◽

Successful Removal

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Predicting the failure of retrograde ureteral stent insertion for managing malignant ureteral obstruction in outpatients

Oncology Letters ◽

10.3892/ol.2015.3961 ◽

2015 ◽

Vol 11 (1) ◽

pp. 879-883 ◽

Cited By ~ 9

Author(s):

JIN-YOU WANG ◽

HAI-LIANG ZHANG ◽

YAO ZHU ◽

XIAO-JIAN QIN ◽

BO DAI ◽

...

Keyword(s):

Ureteral Obstruction ◽

Ureteral Stent ◽

Stent Insertion ◽

Malignant Ureteral Obstruction

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Innovation and new technology in ureteral stents

Insight Urology ◽

10.52786/isu.a.39 ◽

2021 ◽

Vol 42 (2) ◽

pp. 160-168

Author(s):

Tongtra Watcharawittayakul ◽

◽

Manint Usawachintachit ◽

Keyword(s):

Clinical Trials ◽

New Technology ◽

Material Design ◽

Ureteral Stent ◽

Biodegradable Materials ◽

Stent Insertion ◽

Ureteral Stents ◽

Stent Removal ◽

Silicone Polymers ◽

Removal Technique

Ureteral stent insertion is a procedure performed extensively by all urologists. Nevertheless, stent-related symptoms and stent encrustation are still common complications pushing the innovation and development of novel ureteral stents. Developments are focussing on three significant aspects: material, design, and removal technique. Various materials including silicone, polymers, and metals are frequently utilized, with or without an additional coating. The use of biodegradable materials is looking promising but these is a lack of proven clinical trials in association with this in humans. The new designs focus on the reduction of stent-related symptoms through the modification of the bladder end. The new stent removal techniques with extraction strings or novel magnetic end may exclude subsequent cystoscopic procedures. Finally, utilization of a ureteral stent tracker application helps in reminding both physicians and patients to remove the stent at the appropriate time.

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Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy

BMC Urology ◽

10.1186/s12894-021-00912-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei Wang ◽

Xiaoshuai Gao ◽

Jixiang Chen ◽

Zhenghuan Liu ◽

Liao Peng ◽

...

Keyword(s):

Radiation Therapy ◽

Radiation Treatment ◽

Ureteral Stent ◽

Stent Insertion ◽

Rectal Cancer Surgery ◽

Ureteral Stricture ◽

Metallic Stent ◽

Stent Patency ◽

Postoperative Fever

Abstract Background To assess the efficacy and safety of self-expanding metal ureteral stent for the stricture following surgery and/or radiation for malignancy. Methods We performed 36 metal ureteral stent insertion procedures (32 patients) between May 2019 and June 2020. The main inclusion criterion was the patients with ureteral stricture due to surgery and/or radiation treatment for malignancy. The diagnosis of stricture was ascertained by history and radiographic imaging. The etiologies underlying the strictures were: surgery and/or radiation therapy for cervical and rectal cancer, surgery for ovarian cancer. The primary outcome was the stent patency rate, and the secondary outcomes were the postoperative complications and glomerular filtration rate (GFR). Stent patency was defined as stent in situ without evident migration, unanticipated stent exchange or recurrent ureteral obstruction. Cost analysis was calculated from stent cost, anesthesia cost and operating room fee. Results The pre-metallic stent GFR was 22.53 ± 6.55 mL/min/1.73 m2. Eight patients were on double-J stents before insertion of metallic stents. The total annual cost of per patient in our study was $10,600.2 US dollars (range $9394.4–$33,527.4 US dollars). During a median follow-up time of 16 months (range 8–21 months), 27 cases (31 sides, 84%) remained stent patency. Twelve patients died from their primary malignancy carrying a patency stent. Stent migration was observed in 4 patients within 10 months after insertion. Ectopic stents were endoscopically removed and replaced successfully. Three stents were occluded, and no encrustation was seen in our study. Three and four patients had postoperative fever and gross hematuria, respectively. Infection was observed in 2 cases, mandating antibiotics therapy. In addition, postoperative volume of hydronephrosis postoperatively was significantly reduced compared with preoperation (54.18 ± 15.42 vs 23.92 ± 8.3, P = 0.019). However, no statistically significant differences regarding GFR, creatinine levels, blood urea nitrogen and hemoglobin existed between preoperation and last follow-up. Conclusions The current study demonstrated that metal ureteral stent is effective and safe in the treatment of stricture following surgery and/or radiation therapy for malignant cancer. Patients hydronephrosis could be improved by the stent placement.

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