EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY TO REMOVE CALCIFIED URETERAL STENTS THIERRY A . FLAM, M .D .
BERNARD DEBRE, M . D .
MICHEL BROCHABD, M .D . MARC ZERBIB, M .D .
ADOLPHE STEG, M .D .
From the Department of Urology, H6pital Cochin, Paris, France
ABSTRACT-A patient was seen with a large calcification of the renal end of a silicone cathr t, placed to intubate a cutaneous ureterostomy . Because of the stone, withdrawal of the catheter Ica impossible, and the patient presented with obstruction and dilatation of the renal cavities alwi with febrile bacteriuria and renal failure . Extracorporeal shock-wave lithotripsy, done under ii travenous sedation, was found to be an effective noninvasive method to treat such a complicatiozz long-term urinary drainage .
Catheter encrustation and stone formation are a common problem associated with long-term indwelling catheters, including ureteral catheters . Prevention of the ensuing obstructive and infectious complications relies on close patient follow-up and periodic replacement of the catheter . However, replacement of the catheter may not be possible because of the development of calcifications at the renal end of the tube .
Case Report A sixty-two-year-old woman was admitted our institution for a retained left cutaneous u terostomy silicone catheter . The patient had a bilateral cutaneous ureterostomy years earlier for an intractable postradiatioii vesicovaginal fistula . Silicone straight catheters had been used for intubation of th
(A) Left renal ultrasound showing stone at tip of catheter and permeability of rest of tuh' , Computerized tomography scan . Obstruction and enlargement of left ureteral catheter ; right ureteral ter is patent . FIGURE 1 .
UROLOGY / AUGUST 1990 / VOLUME XXXVI, NUN
z,terostomies with replacement every three phi tlis, the last time three months prior to ad;54(m . At that time, bacteriuria with multiple e jes was found and treated accordingly . The i ht kidney had been nonfunctional for several =~ji,mnths . On admission, findings on physical ex1,,,ination were normal and urine specimen wed bacteriuria with Proteus and Escheriua coli . Serum creatinine was 428 ,amol/L . he left catheter could not be removed by sime' traction, even under intravenous sedation . ef1 : renal ultrasound showed thickening and cclusion of the renal end of the ureteral cathedilatation of the renal cavities, and pelvic enal stone (Fig . 1A) . Computerized tomograshowed the thickening to be due to 0 y ,,(,,an :=;stone encrustation of the catheter and confiTrl~~'d the stone-related obstruction of the Catheter with dilatation of the cavities (Fig . IB) . The stone was treated by extracorporeal shock-wave lithotripsy (ESWL) under intravenbus sedation, using the Sonolith 2000 GU lithe triptor (Technomed) . The catheter was easih; removed following 400 shocks, and an additimal 800 shocks were given to the stone for satisfactory fragmentation . The patient was discharged on postoperative day 8 with a serum c.rcatinine of 130 µmol/L .
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Comment As reported previously, silicone catheters are not exempt from stone encrustation with secondary obstruction and infection .' In our patient, a silicone catheter had been in place for only three months before significant stone formation occurred at its renal end . Unlike most reports of similar encrustated silicone catheters our patient had no previous history of stone disease . Although other methods are available to treat such a condition, including open surgery and percutaneous nephrolithotomy,`' ESWL under intravenous sedation offered our patient a convenient noninvasive treatment . , 2 _ 3
75014 Paris, France (DR . FLAM) References 1 . Abber JC, and Kahn RI : Pyelonephritis from severe encrustation on silicone ureteral stents : management, j Urol 130 : 763 (1983) . 2 . Lupu AN, Fuchs GJ, and Chaussy CG : Calcification of ureteral stent treated by extracorporeal shock wave lithotripsy, j Urol 136 : 1297 (1986) . 3 . Spirnak JP, and Resnick MI : Stone formation as a complication of indwelling ureteral stents : a report of 5 cases, j Urol 134 : 349 (1985) . 4 . Sujka SK, and Kriegler SB : Percutaneous technique to remove calcified ureteral stents, Urology 24 : 557 (1987) .