title: Forgotten, encrusted ureteral stents: a challenging problem with an endourologic solution.
abstract: OBJECTIVE
  Forgotten, encrusted ureteral stents represent a difficult problem for urologists, and a consensus on the best therapeutic approach is lacking. We present our experience with endoscopic management of this challenging problem and discuss the chosen treatment combinations.
  
  
  METHODS
  Five women and four men aged 31 to 71 years (mean 50.2 years) with 10 stents indwelling for 6 to 85 months (mean 24.1 months) were treated in our department. Stent encrustation and the associated stone burden were evaluated by plain radiographs and intravenous urography. Treatment decisions were based on the clinical presentation and imaging findings. Three stents in two patients had minimal or slight encrustations.
  
  
  RESULTS
  The mean number of procedures per patient was 2.1 (range 1-4). Percutaneous nephrolithotomy was performed in eight patients and retrograde ureteroscopy with or without intracorporeal lithotripsy in seven cases. Cystolitholapaxy or percutaneous cystolithotripsy was used to manage the distal portion of the encrusted stent in two cases. Extracorporeal shockwave lithotripsy was performed in only two patients. All stents and the associated stones were eventually removed without any complications.
  
  
  CONCLUSIONS
  Combined endourologic techniques can achieve safe removal of forgotten stents if treatment is tailored to the volume of encrustation and associated stone. Imaging evaluation and documentation of negative urine culture are imperative prior to any attempt to remove the stent.
authors.affiliation: Department of Urology, University Hospital of Larissa, Larissa, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Aravantinos
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Karatzas
authors.forename: Vassilios
authors.initials: V
authors.lastname: Tzortzis
authors.forename: Michael
authors.initials: M
authors.lastname: Melekos
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005549:Foreign-Body Reaction / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents / Q000009:adverse effects*; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery*