Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Novel approach for removal of heavily encrusted ureteral stent

Curtis Clark¹, Jason Bylund¹, Matthew Paszek¹, Chad LaGrange², Vernon M. Pais Jr³

1 University of Kentucky, Division of Urology, Lexington, Kentucky, USA
2 University of Nebraska, Division of Urology, Omaha, Nebraska, USA
3 Dartmouth Hitchcock Medical Center, Section of Urology, Lebanon, New Hampshire, USA
Address correspondence to Dr. Vernon M. Pais, Section of Urology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 USA

Canadian Journal of Urology 2009, 16(5), 4831-4835.

Abstract

Objectives and background: 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.

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