Combined retrograde-anterograde endourological approach for encrusted ureteral stents: results from a single-center retrospective series.

PURPOSE: We aim to evaluate outcomes of a combined retrograde-percutaneous endourological approach for encrusted ureteral stents and identify predictors of 30-day postoperative complications.

METHODS

We retrospectively analyzed 82 adult patients (48.8% men, 51.2% women) who underwent combined endourological treatment for encrusted ureteral stents (February 2020-December 2024). Preoperative imaging included abdominal X-ray and CT scan; encrustation severity was graded using the KUB score. All procedures were performed under spinal anesthesia by two in-tandem surgeons. Multivariable logistic regression identified predictors of complications.

RESULTS

The median patient age was 53.4 (IQR 38.2-64.0) years; median stent dwell time was 8.0 months. The median KUB score was 5.0 (IQR 3.0-5.25); 8.5% of patients had scores ≥ 9. Successful stent removal was achieved in 100% of cases. Intraoperative apparent stone-free status was attained in 85.4% of patients. Median operative time was 83.0 min. There were 19 complication events occurring in 17 patients, with most events being minor (Clavien grades 1-2 events = 13). There were only 6 major complication events (Clavien ≥ 3), including one case of sepsis requiring intensive care admission. Patients with complications had a significantly longer median hospital stay (4.5 vs. 3.0 days; p < 0.01). Positive stone culture was more frequent in the complication group (29.4% vs. 13.8%, p = 0.13). On multivariate regression analysis, there was no significant association between complications and stent dwelling time, KUB score, and operative duration.

CONCLUSION

Combined endourological approach to encrusted stent removal achieves complete stent removal with near-complete stone removal along with a low rate of major complications, supporting its use as a viable treatment option for patients with encrusted ureteral stents.