輸尿管導管結殼處理: 個案報告及文獻回顧

許靖承 林承家 陳鴻毅 吳翊豪

基隆長庚醫院 外科部 泌尿科

Ureteral stent encrustation: Frustrated complication of ureteral stent. Case report and literature review

Ching-Cheng Hsu, Cheng-Chia Lin, Hung-Yi Chen, Yi-Hao Wu

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Introduction: Encrustation is a common complication that can occur following placement of ureteral stent. Sometime it leads to serious complication. The management often requiring multimodal strategy to remove the stent. In this article we presented 2 case of ureteral stent encrustation, and review the latest update for this complication.

Case presentation:

Case1

A 24-year-old male presented with right flank plain, KUB showed right lower ureteral stone. He was Vietnamese, an immigrant worker. After discussion for treatment option, semi-rigid URS with 6*26 double J <Cook> placement was performed and ureteral stricture was noted during operation. Due to misinterpretation of patient instruction of post-op care he had been loss follow up for 2 years. And came back with right flank discomfort. KUB showed double J proximal loop stone encrustation. Then double J removal under general anesthesia was arranged. During operation double J was difficult to remove, which proximal and distal J shape part was coated with stone fragment. Ureteroscope was advanced and cut double J into 2 pieces with Holium laser. Distal part was removed then proximal part was pushed back to renal pelvis. Flexible uretero-renoscope was advanced and disintegrated the residual proximal part into 3 pieces. Total operation time was 120 mins. After operation patient was discharged after awake and during follow up no complication was noted.

Case2

A 55-year-old male with came to Urology OPD due to left upper ureteral stone with moderated hydronephrosis. URS-SM was arrange ureteral stricture with stone bedding was noted at upper and lower ureter part, double J was placed. Hydronephrosis was noted after double J removal. 2^nd time URS-SM showed residual upper ureteral stone with ureteral stricture status post balloon dilatation. 3^rd time double J revision was arranged 3 months later with 6*24 Loop Polaris <Boston>. During 4^th time double J revision difficult double J removal was noted with stone encrustation at proximal loop. Thus double J was cut by holium laser into 2 pieced, the distal part was removed first. Proximal part of the double J was pushed back, stone coated with firm C-shape, stone coating was disintegrated by laser smoothly, the C shape can extent to linear shape, proximal part was then removed. Ureter mucosal was partial erosion, Fr 4.7*26 double J inserted smoothly. Total operation time was 150mins. Patient discharge at postoperative day1 without significant complication. Further revision of double will be arranged.

Discussion:

While the implantation of ureteral stents is intended to relieve the symptoms and consequences of a variety of urological disorders, encrustation of stents is a severe impediment that can negatively affect patient safety and quality of life, especially in those individuals who need prolonged stenting.

Conclusion:

The ubiquity of ureteral stents in urology practice mandates updated knowledge about the prevention of stent encrustation, identification of high risk patients and preparedness for removal using multimodal techniques.