Since its introduction in 1970, ureteral stents hold an indispensable tool in urologic practice. Primarily serving to drain the upper urinary tract, their usage is indicated in a wide range of both emergency and elective scenarios. Degree of encrustation may be varied from simple deposit of mineral crystal on to the surface of the stent to total encrustation on the distal and proximal coil. Stent encrustation is a difficult challenge for the clinician and in the modern era, minimally invasive endourological approaches dominate in its management. The objective of this video is to showcase how we managed encrusted stent in our center. Since its introduction in the seventies, ureteral stents hold an indispensable tool in urologic practice. Primarily serving to drain the upper urinary tract, their usage is indicated in a wide range of both emergency and elective scenarios. Degree of encrustation may be varied from simple deposit of mineral crystal on to the surface of the stent to total encrustation on the proximal and distal coil. Stent encrustation poses a difficult challenge for the urologist and in the modern era, minimally invasive endourological approaches dominate in its management. The following video will demonstrate our approach on total stent encrustation.

Three cases of total encrustation of the distal and proximal coil of ureteral stent managed with combined holmium laser and ultrasonic lithotripsy / cystolapaxy (for distal coil), ureteroscopy laser tripsy and Supine Percutaneous Nephrostolithotomy with holmium laser and ultrasonic lithotripsy (for Proximal coil). Three cases of forgotten stent with complete encrustation on both end of the coil was managed with combined holmium laser and ultrasonic lithotripsy with cystolapaxy (for distal coil), ureteroscopy laser tripsy (for mid encrustations) and Supine Percutaneous Nephrostolithotomy with holmium laser and ultrasonic lithotripsy (for Proximal coil).

Two cases were successfully managed in one setting while the other was completed on the second session after 48 hours. Average operation time was 280 minutes. No morbidity was noted.

Total encrustation of ureteral stents can be a difficult problem to treat. A stepwise approach is required to safely render the patient stent free. Endourological interventions now represent the mainstay of management and can achieve good outcomes, however a multimodal approach may be required, along with a staged procedure where necessary.