Successful Endourological Management of Encrusted Metallic Ureteral Stents: A Case-Series of Three Patients

Background and Clinical Significance: Metallic stents represent a breakthrough in the treatment of ureteric obstruction, improving patient quality of life. Despite their advantages, management of encrustation remains a difficult complication to address. This case series highlights the rare occurrence of permanent ureteral Wallstents remaining indwelling for over 20 years. It emphasizes that the function of these older devices can be successfully preserved using minimally invasive techniques. Case Presentation: This case series details three patients, two males, aged 75 and 69 years, diagnosed with colon cancer, and one female, aged 67 years, with cervical cancer, who presented with obstructive uropathy due to extrinsic malignant compression. As a therapeutic strategy, permanent ureteral Wallstents were placed in all three patients. Over time, the stents developed significant encrustation, leading to secondary obstruction. Clinical manifestations of this complication varied, ranging from asymptomatic hydronephrosis to acute symptomatic uropathy characterized by fever and localized pain. All cases were treated endoscopically with Ho:YAG laser lithotripsy, and urine flow was successfully restored. During the follow-up period, one patient experienced two recurrences that were managed with the same technique, another remained completely symptom-free, and the third was lost to long-term follow-up. Remarkably, the stents have remained functional for over 20 years post-implantation. Conclusions: This is a rare report documenting permanent ureteral Wallstents with such prolonged indwelling time. Furthermore, our findings suggest that through minimally invasive techniques, the function of these devices can be successfully preserved.