Combined endoscopic surgery in the prone-split leg position for successful single-session removal of an encrusted ureteral stent: a case reportReportar como inadecuado




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Journal of Medical Case Reports

, 8:128

First Online: 17 April 2014Received: 16 September 2013Accepted: 09 December 2013DOI: 10.1186-1752-1947-8-128

Cite this article as: Isero, T., Hamamoto, S., Koiwa, S. et al. J Med Case Reports 2014 8: 128. doi:10.1186-1752-1947-8-128

Abstract

IntroductionAlthough encrusted stents may lead to some unwanted complications including urinary tract obstruction, urinary sepsis, and potential loss of kidney function, there is currently no consensus on the most efficient method for managing stents that are intentionally left in situ. This is the first report describing the management of an encrusted stent using combined endoscopic surgery in the prone split-leg position in a single session.

Case presentationA 47-year-old Asian man presented with left flank pain and macrohematuria. The patient had undergone left ureteral stenting three years previously for the treatment of left ureteral stones and hydronephrosis; however, he was lost to follow-up before the treatment for the ureter stones was completed. Therefore, the ureteral stent and stones were not removed. An abdominal radiograph and a noncontrast computed tomography scan showed encrustation along the retained stent with stone burdens in the kidney and ureter. The ureteral stent could not be removed by cystoscopy after shock wave lithotripsy of the left ureteral stones. Therefore, endoscopic lithotripsy combined with flexible ureteroscopy and miniature nephroscopy was performed with the patient in the prone split-leg position. All the stones and the encrusted ureteral stent were successfully removed in a single session.

ConclusionsIn this case, percutaneous nephrolithomy in addition to flexible ureteroscopy was preferred because severe encrustation of the proximal stent and ureteral stones complicated the therapeutic strategy. Combined endoscopic techniques in the prone split-leg position can achieve successful and safe management of encrusted stents.

KeywordsEncrusted stent Combined endoscopic surgery Prone split-leg position AbbreviationsCTComputed tomography

ECIRSEndoscopic combined intrarenal surgery

fURSflexible URS

mini-PNLminiature percutaneous nephrolithotripsy

SWLShock wave lithotomy

URSUreteroscopy.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-8-128 contains supplementary material, which is available to authorized users.

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Autor: Tetsuya Isero - Shuzo Hamamoto - Satoshi Koiwa - Hiroyuki Kamiya - Yoshihiro Hashimoto - Takahiro Yasui - Yutaka Iwase - Ke

Fuente: https://link.springer.com/



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