Combined retrograde-anterograde endourological approach for encrusted ureteral stents: results from a single-center retrospective series

Purpose: We aim to evaluate outcomes of a combined retrograde-percutaneous endourological approach for encrusted ureteral stents and identify predictors of 30-day postoperative complications. Methods: We retrospectively analyzed 82 adult patients (48.8% men, 51.2% women) who underwent combined endourological treatment for encrusted ureteral stents (February 2020-December 2024). Preoperative imaging included abdominal X-ray and CT scan; encrustation severity was graded using the KUB score. All procedures were performed under spinal anesthesia by two in-tandem surgeons. Multivariable logistic regression identified predictors of complications. Results: The median patient age was 53.4 (IQR 38.2-64.0) years; median stent dwell time was 8.0 months. The median KUB score was 5.0 (IQR 3.0-5.25); 8.5% of patients had scores ≥ 9. Successful stent removal was achieved in 100% of cases. Intraoperative apparent stone-free status was attained in 85.4% of patients. Median operative time was 83.0 min. There were 19 complication events occurring in 17 patients, with most events being minor (Clavien grades 1-2 events = 13). There were only 6 major complication events (Clavien ≥ 3), including one case of sepsis requiring intensive care admission. Patients with complications had a significantly longer median hospital stay (4.5 vs. 3.0 days; p < 0.01). Positive stone culture was more frequent in the complication group (29.4% vs. 13.8%, p = 0.13). On multivariate regression analysis, there was no significant association between complications and stent dwelling time, KUB score, and operative duration. Conclusion: Combined endourological approach to encrusted stent removal achieves complete stent removal with near-complete stone removal along with a low rate of major complications, supporting its use as a viable treatment option for patients with encrusted ureteral stents.