V1724: Endoscopic Management of Tissue Ingrowth into the Proximal and Distal Components of a Resonance Ureteral Stent
VideoIntroduction and Objectives
Management of ureteral obstruction in the chronically ill patient can be challenging. The Resonance stent, made of coiled Chromium, Molybdenum and Titanium alloy, can be deployed for up to 1 year in the obstructed ureter with the advantage of decreased rates of infection and encrustation. We noted tissue ingrowth into the proximal and distal curls of a Resonance stent.
A 75 year old man with multiple comorbidities and a ureteral obstruction was managed with a Resonance ureteral stent. The stent, which upon deployment was in pristine position, had migrated into the proximal ureter. The stent exchange was complicated by significant ingrowth of ureteral urothelium into the proximal and distal coils of the stent. We removed the stent using a minimally invasive endourologic technique.
The overlying urothelium of the proximal coil was visualized with a flexible ureteroscope and gently incised with a holmium laser. The distal end of the stent was released from tissue ingrowth with passage of a 9-11 35-cm ureteral access sheath over the Resonance stent. This technique would not free the proximal coil. As such, under direct vision, the Resonance stent was incised with the laser in two places for removal of the distal coil and shaft. After removal of this component, improved access to the proximal coil allowed for removal of two residual proximal coil fragments without harm to the renal collecting system.
Resonance stent placement is rarely complicated by tissue ingrowth. Tissue ingrowth may have been a function of the immobility of the stent due to proximal migration. We demonstrate an endoscopic technique for removal of the Resonance stent in its entirety.