Management of forgotten ureteral stents with holmium laser

Forgotten ureteral stents represent a difficult problem for urologists, and a consensus on the best therapeutic approach is lacking. We present our experience with endoscopic management of this challenging problem and discuss the chosen treatment combinations. We retrospectively reviewed records of the management of eight cases of forgotten stents between 2002 and 2007. The mean patient age was 41.1 years (21 years to 68 years), and the mean duration of stents in the urinary system was 16.1 months (7 months to 3 years). The stents were severely calcified and encrusted in all patients. Advanced renal failure secondary to hydronephrosis because of severe encrustation and stone formation over the stent was seen in two patients. Four patients were treated with percutaneous nephrolithotomy (PCNL) alone, two were treated with PCNL and ureteroscopy (URS), and the other two underwent a combination of extracorporeal shock wave lithotripsy (ESWL) and URS .All stents and the associated stones were eventually removed without any complications. Combined endourologic techniques with holmium laser can achieve safe removal of forgotten stents if treatment is tailored to the volume of encrustation and associated stone. Imaging evaluation and documentation of urine cultures with negative findings are imperative prior to any attempt to remove the stent.