OBJECTIVES AND BACKGROUND: We describe a novel approach for removal of a retained, heavily encrusted ureteral stent via combined laparoscopic cystolithotomy and pyelolithotomy. Due to noncompliance, our patient with a history of nephrolithiasis returned with large proximal and distal stones 2.5 years after placement of a left ureteral stent.
METHODS: Laparoscopy was performed using three 12 mm ports and two 5 mm ports. The bladder was opened in the midline and the stent divided at the ureteral orifice. The bladder stone (4.7 cm x 4 cm) was placed in a retrieval bag and the cystotomy closed with vicryl suture. The proximal ureter and renal pelvis were dissected free and incised. The stent with 2.3 cm x 1.5 cm stone on the proximal curl was removed. The incision was closed transversely with vicryl suture.
RESULTS: The patient's recovery was uneventful, including drain removal prior to discharge on postoperative day 3. The foley was removed after a negative cystogram 7 days later. Analysis revealed calcium phosphate and struvite stones. Left ureteroscopy 2 months later revealed a widely patent proximal ureter. No complications have been identified.
CONCLUSIONS: Laparoscopic cystolithotomy with stent division combined with pyelolithotomy can be performed safely and successfully as a single procedure to remove the heavily encrusted ureteral stent.