An Effective Classification System for the Treatment of Encrusted Ureteral Stents

Abstract

Background: We created a classification system for encrusted ureteral stents (ES) (Grading system for Additional lithiasis and uReteral Stent cAlcification -GARSA-, I-III grades), we demonstrate its utility for predicting the surgical outcome and the need of complex surgery.

Methods: Retrospective review of patients with ES; clinico-demographics, additional lithiasis (AL), stent calcification characteristics, surgeries performed, complications and stone free rate were collected. Chi-square was used to compare the categorical variables and Kruskal-Wallis test for the comparison > 2 numerical groups; a p-value < .05 was considered significant.

Results: We included 190 ES; 163 (85.8%) stents underwent one-time surgical removal. Most Grade I catheters were removed in a single surgery, without invasive/multimodal therapy; Grade II-III catheters required multimodal and invasive therapies. The presence of AL in kidney increased the number of surgical interventions performed in Grade I/II catheters (p < 0.05) and the likelihood of requiring multimodal (Grade I: 90%, Grade II: 83.3%, Grade III: 100%) or invasive surgery (Grade I: 38.1%, Grade II 58.3%, Grade III 90.9%) to achieve successful treatment.

Conclusions: Incorporating both the calcified stent characteristics and the presence of AL, GARSA score can be used to determine the selection of the optimal surgical approach for patients with encrusted stents.

Keywords: Lithotripsy; percutaneous nephrolithotomy; stent; ureteroscopy; urinary calculi; urologic surgical procedures.