Novel approach for removal of heavily encrusted ureteral stent.
OBJECTIVE
We describe a novel approach for removal of a retained, heavily encrusted ureteral stent via combined laparoscopic cystolithotomy and pyelolithotomy. Due to noncompliance, our patient with a history of nephrolithiasis returned with large proximal and distal stones 2.5 years after placement of a left ureteral stent.


METHODS
Laparoscopy was performed using three 12 mm ports and two 5 mm ports. The bladder was opened in the midline and the stent divided at the ureteral orifice. The bladder stone (4.7 cm x 4 cm) was placed in a retrieval bag and the cystotomy closed with vicryl suture. The proximal ureter and renal pelvis were dissected free and incised. The stent with 2.3 cm x 1.5 cm stone on the proximal curl was removed. The incision was closed transversely with vicryl suture.


RESULTS
The patient's recovery was uneventful, including drain removal prior to discharge on postoperative day 3. The foley was removed after a negative cystogram 7 days later. Analysis revealed calcium phosphate and struvite stones. Left ureteroscopy 2 months later revealed a widely patent proximal ureter. No complications have been identified.


CONCLUSIONS
Laparoscopic cystolithotomy with stent division combined with pyelolithotomy can be performed safely and successfully as a single procedure to remove the heavily encrusted ureteral stent.
University of Kentucky, Division of Urology, Lexington, Kentucky, USA.
Curtis
C
Clark
Jason
J
Bylund
Matthew
M
Paszek
Chad
C
Lagrange
Vernon M
VM
Pais
D020878:Device Removal / Q000379:methods*; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011475:Prosthesis Failure; D015607:Stents; D014057:Tomography, X-Ray Computed; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography