title: Combined endoscopic surgery in the prone-split leg position for successful single-session removal of an encrusted ureteral stent: a case report.
abstract: BACKGROUND
  Although encrusted stents may lead to some unwanted complications including urinary tract obstruction, urinary sepsis, and potential loss of kidney function, there is currently no consensus on the most efficient method for managing stents that are intentionally left in situ. This is the first report describing the management of an encrusted stent using combined endoscopic surgery in the prone split-leg position in a single session.
  
  
  METHODS
  A 47-year-old Asian man presented with left flank pain and macrohematuria. The patient had undergone left ureteral stenting three years previously for the treatment of left ureteral stones and hydronephrosis; however, he was lost to follow-up before the treatment for the ureter stones was completed. Therefore, the ureteral stent and stones were not removed. An abdominal radiograph and a noncontrast computed tomography scan showed encrustation along the retained stent with stone burdens in the kidney and ureter. The ureteral stent could not be removed by cystoscopy after shock wave lithotripsy of the left ureteral stones. Therefore, endoscopic lithotripsy combined with flexible ureteroscopy and miniature nephroscopy was performed with the patient in the prone split-leg position. All the stones and the encrusted ureteral stent were successfully removed in a single session.
  
  
  CONCLUSIONS
  In this case, percutaneous nephrolithomy in addition to flexible ureteroscopy was preferred because severe encrustation of the proximal stent and ureteral stones complicated the therapeutic strategy. Combined endoscopic techniques in the prone split-leg position can achieve successful and safe management of encrusted stents.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Isero
authors.affiliation: Department of Urology, Toyota Kosei Hospital, 500-1 Ibohara, Jyousui-cho, Toyota City, Aichi 470-0396, Japan. hamamo10@med.nagoya-cu.ac.jp.
authors.forename: Shuzo
authors.initials: S
authors.lastname: Hamamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koiwa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kamiya
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yasui
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Iwase
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kohri
mesh_terms: D020878:Device Removal / Q000379:methods*; D004868:Equipment Failure; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D015607:Stents; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*
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