Forgotten ureteral stents: Risk factors, complications and management

Abstract

Objectives: To assess complications of neglected stents, risk factors for the occurrence of complications, and management options and outcomes.
Subjects and methods: A prospective study including patients presenting to our center with neglected polyurethane ureteral stents (indwelling for more than 6 months in the period from February 2012 to September 2015). We noted the complications of neglected stents (urinary tract infections (UTI), urinary obstruction, elevated creatinine, encrustations and stent fragmentation), management challenges (need for complex endo-urologic or open procedures). We evaluated potential risk factors for these complications (duration of stenting, lack of urinary acidification, cause of stent placement).
Results: The study included 68 patients with mean age 49.3 ± 12.6 years 80.9% were males. Mean stenting duration 17.3 ± 12.7 months. A total of 29% of patients received urine acidifier while the stent was indwelling, 92% were stone formers, 60% presented with UTI and 25% presented with elevated creatinine. Preoperative non-contrast spiral CT abdomen and pelvis showed encrustations on the stent in 23.5% of patients and fragmented stent in 13%. The stent was removed by cystoscopy only as an outpatient procedure in 26 (38.3%) cases (7 of them with encrustation) while 42 (61.7%) cases needed more than simple cystoscopy. Management challenges included need for complex endourological interventions (URS, PCNL, cystolithotripsy or even open surgery). Lack of urinary acidification was a significant risk factor for UTI and stent fragmentation (P-value = 0.038 and 0.006, respectively). Stone former patients needed complex interventions (P = 0.046). UTIs were more likely with longer duration of stenting (P = 0.027).
Conclusion: Forgotten ureteral stents are associated with significant complications. Urinary acidification is protective against complications. Patients with stones are more liable to forgotten stents complications.