title: [Single session cystolitholapaxy and PCNL for encrusted DJ stent with large associated stone burden].
abstract: BACKGROUND
  Ureteral stent use is commonplace in urology to prevent or relieve ureteral obstruction. If ureteral stents are neglected, they can cause severe morbidity due to migration, occlusion, encrustation, breakage, stone formation, and even death, due to life-threatening urosepsis or complications related to operative intervention. Extracorporeal shockwave lithotripsy, ureterorenoscopy, electrohydraulic lithotripsy, laser lithotripsy, and percutaneous nephrolitholapaxy (PCNL) have been reported for forgotten ureteral stent management, but currently there are no guidelines for this challenging situation and only few algorithms have been introduced by some studies.
  
  
  METHODS
  We present a case of a man presenting with an encrusted left double J (DJ) stent, inserted two years before, and bulky radiolucent lithiasis at both ends of the stent. The patient was studied with intravenous pyelogram and non contrast-enhanced computed tomography, and then treated with cystolithotripsy and PCNL in a single session.
  
  
  RESULTS
  Complete clearance of the stones was obtained and the DJ stent was removed without breaking from the percutaneous access.
  
  
  CONCLUSIONS
  Neglected stents still represent a challenge in urology: while endourology remains the best option for treatment, the management of ureteral stents should be based on follow-up and prevention, using for example a computerized warning and stent retrieval software system.
authors.affiliation: Clinica Urologica I - Università degli Studi di Milano. Fondazione IRCCS Ospedale Maggiore Policlinico, Ca' Granda, Milano, Italy. uropoli@unimi.it
authors.forename: Mario
authors.initials: M
authors.lastname: Ferruti
authors.forename: Stefano
authors.initials: S
authors.lastname: Paparella
authors.forename: Gabriele
authors.initials: G
authors.lastname: Cozzi
authors.forename: Isabella
authors.initials: I
authors.lastname: Oliva
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Finkelberg
authors.forename: Augusto
authors.initials: A
authors.lastname: Maggioni
authors.forename: Francesco
authors.initials: F
authors.lastname: Rocco
mesh_terms: D003558:Cystoscopy / Q000379:methods*; D053159:Dysuria / Q000209:etiology; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000601:surgery; D053039:Ureterolithiasis / Q000209:etiology / Q000601:surgery*