Multimodal management of urolithiasis for forgotten severely calcified ureteral JJ stent: our experience at King Hussein Medical Center

ABSTRACT

To evaluate the management of forgotten ureteral JJ stent with sever encrustation and stone formation. This is a retrospective study which was conducted at King Hussein Medical Center during the period January 2005- April 2009, fifteen patients [10 male and 5 female] aged between 25- 60 years, with severe JJ stent encrustations were incorporated in this study. Three with severe encrustation of the whole stent, 5 with severe encrustation of both ends, 5 with ureteric part and bladder end encrustation, and 2 with bladder end encrustation only. The duration of forgotten JJ range from 6 months -12 years. Multimodal therapies were used for the management. All patients were stents and stone free after 1-4 approach [ureteroscopy, percutaneous nephrolithotomy, cystoliholapaxy and open surgery] in multisessions. All patients were treated by minimally invasive endourological procedure in all sessions except one which required open ureterolithotomy. One major complication was encountered, small bowel injury which was managed without events. Severe encrustation of the JJ stents requires multimodal therapy for managing this complex problem; each patient may need multiple approaches in one or multiple sessions. Open surgery may be indicated when minimally invasive procedures fail