What is the treatment for urinary stent occlusions?

Management of Urinary Stent Occlusions

For urinary stent occlusions, the recommended first-line treatment is stent replacement, with consideration of changing the stent type if occlusion recurs. 1

Causes and Risk Factors for Stent Occlusion

• Urinary stones and indwelling urethral catheters are significant risk factors for double-J stent occlusion 1
• Encrustation, infection, and prolonged stent dwelling time (>12 months) contribute to stent occlusion and potential breakage 2, 3
• Stent material and design influence the rate of occlusion, with some materials being more prone to encrustation than others 3, 4

Management Algorithm

Initial Management

• Replace the occluded stent as the primary intervention 1
• If the occlusion prevents passage of a guidewire through the stent, change to a different type of stent material or design 1
• Consider shortening the interval between stent replacements from 12-13 weeks to 6-8 weeks in patients with recurrent occlusions 1

For Complicated Cases

• For severe encrustation or fragmented stents, a combined endoscopic and surgical approach may be necessary 2
• In cases where stent replacement fails due to complete occlusion:
  • Percutaneous nephrostomy should be placed to relieve obstruction 5
  • Antegrade access with conversion to a percutaneous nephroureteral stent may be required 5

For Stent Occlusions with Complications

• If enlarging urinoma, fever, increasing pain, ileus, fistula or infection are present:
  • Urinary drainage should be performed via ureteral stent 5
  • This may be augmented by percutaneous urinoma drain, percutaneous nephrostomy, or both 5

Prevention Strategies

• Regular monitoring with sonography every 2 months for patients with indwelling stents 2
• Routine stent exchange after 12 months, even if asymptomatic 2, 3
• Consider drug-eluting stents or biodegradable stents in patients with recurrent occlusions 4
• For patients with anatomical factors contributing to occlusion, stent design selection should account for the curved nature of the ureter in the human body 6

Special Considerations

• In patients with urinary diversion (e.g., after cystectomy), retrograde stent placement may be challenging due to difficult visualization of the ureteric opening in the bowel conduit 5
• For these patients, image-guided percutaneous antegrade access with either immediate or delayed conversion to retrograde percutaneous nephroureterostomy is often preferred 5
• Internal double-J stents tend to occlude quickly in ileal conduits due to mucous plugging 5

Complications of Delayed Management

• Forgotten or occluded stents can lead to significant morbidity including severe encrustation, infection, and renal dysfunction 1, 2, 3
• Multiple procedures may be required to manage complications of long-term occluded stents 3
• Stent fracture can occur with prolonged occlusion, requiring more complex retrieval procedures 2