Smartphone-based stent tracking application for prevention of forgotten ureteral double-J stents: a prospective study

ABSTRACT Purpose: Retained or forgotten ureteral stents (FUS) have a potential to cause significant morbidity as well as medico-legal issues and increased cost. We aimed to evaluate the efficacy and usefulness of smartphone-based Ureteral Stent Tracker (UST) application and compare the results with basic appointment card system to prevent FUS, prospectively. Materials and Methods: A total of 90 patients who underwent ureteroscopic stone treatment procedure with indwelling DJ stents were equally distributed into two groups. In group-1, patients were followed using UST application. In group-2, only appointment cards were given to the patients. Two groups were compared in terms of stent overdue times and complete lost to follow up rates. Results: Forty-four patients in group-1 and 43 patients in group-2 completed the study. Among patients, 22.7% in group-1 and 27.9% in group-2 did not return for the stent removal on the scheduled day. In group-1, these patients were identified using the UST and called for the stent removal on the same day. After 6 weeks of maximal waiting period, mean overdue times in group-1 and group-2 were 3.5 days and 20 days, respectively (p = 0.001). In group-2, 3 patients (6.9%) were lost to follow up, while in group-1, it was none (p = 0.001). Conclusions: We found that the patients who were followed by the smartphone-based UST application has less overdue times and lost to follow up cases compared to the basic appointment card system. The UST application easily follows patients with indwelling ureteral stents and can identify patients when overdue.

Endourological Management of Forgotten Encrusted Ureteral Stents

PURPOSE: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. MATERIALS AND METHODS: From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. RESULTS: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. CONCLUSION: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

Endourologic management of severely encrusted ureteral stents.

BACKGROUND: Ureteral stents are in common use in urologic practice. Even though the stent is a valuable urological tool, its use has two widely encountered complications, namely, stent encrustation and stone formation. These complications are difficult to manage; but endourologic surgery, which is minimally invasive, has become the first choice in the treatment for encrustation and stone formation. MATERIAL AND METHOD: Eight patients with severely encrusted ureteral stents were treated by endourologic techniques. One patient had severe encrustation at all sites of the stent and was treated by percutaneuos nephrolithotomy, ureteroscopy with intracorporeal lithotripsy and cystolitholapaxy. Five patients with severe encrustation at both ends of the stent were treated with percutaneous nephrolithotomy and cystolitholapaxy (4 cases) and with extracorporeal shock wave lithotripsy (ESWL) and cystolitholapaxy. The last two patients with severely encrusted ureteral stents at the bladder end were treated with percutaneous cystolithotomy with intracorporeal lithotripsy and by optical lithotrite, respectively. RESULTS: All cases were stone free and stent free in one session without complication. The average approaches were 1.9 (range 1-3). All stents were removed intact and no subsequent stent was required following the removal of the problematic stent. CONCLUSION: Endourologic surgery which is minimally invasive surgery, is the first choice of treatment for the management of severely encrusted ureteral stents with good results in one session without complications and no subsequent stent is necessary. The authors recommend removing the stent as soon as possible or change the new stent every 3 months for decreasing the incidence of these complications.

Formação de cálculo uretral ao redor de um corpo estranho: relato de um caso / Formation of an urethral calculus around a foreign body: a case report

Os cálculos uretrais primários são raros no ocidente. O seu desenvolvimento freqüentemente está associado a alterações prévias do fluxo urinário, como divertículos uretrais, áreas de estenose ou corpos estranhos impactados. Os autores relatam um caso de um paciente de 77 anos de idade que se apresentou com queixa de retenção urinária aguda e dor na região genital. O diagnóstico de uretrolitíase foi feito e, mediante estudos radiográficos, um objeto estranho, cilindro de madeira, foi identificado no interior do cálculo.

Handling 405 cases of ureteric obstruction

This is a retrospective study of 405 cases of adult patients with ureteric obstruction. The aim of the study was to categorize these cases according to the cause of obstruction and its treatment. The medical records of patients with ureteric obstruction were reviewed with regard to the causes of obstruction and how it was treated from January 1995 until June 1995. The causes of obstruction were ureteric stones in 381 cases, a large proportion of the cases [319 patients] were treated by Extra Corporeal Shock Wave Lithotripsy [ESWL]. In 12 cases the cause of obstruction was pelvic tumors, and they were treated by stenting. In 6 other cases ureteric stricture was the cause. In 3 cases the cause of obstruction was retroperitoneal fibrosis, 2 of these cases responded to steroid therapy with stenting.post pelvic surgery, and accidental ureteric ligation caused the obstruction in 3 other cases. Conclusions: Calculus disease is still the most common cause of ureteric obstruction. Extra Corporeal Shock Wave Lithotripsy [ESWL] has been performed successfully in 83% of cases without adjunct modalities. External drainage by percutaneous nephrostomy [PCN] is undoubtedly the most effective form of treating renal obstruction in emergencies