An Effective Classification System for the Treatment of Encrusted Ureteral Stents.

Background: We created a classification system for encrusted ureteral stents (ES) (Grading system for Additional lithiasis and uReteral Stent cAlcification -GARSA-, I-III grades), we demonstrate its utility for predicting the surgical outcome and the need of complex surgery.

Methods: Retrospective review of patients with ES; clinico-demographics, additional lithiasis (AL), stent calcification characteristics, surgeries performed, complications and stone free rate were collected. Chi-square was used to compare the categorical variables and Kruskal-Wallis test for the comparison > 2 numerical groups; a p-value < .05 was considered significant.

Results: We included 190 ES; 163 (85.8%) stents underwent one-time surgical removal. Most Grade I catheters were removed in a single surgery, without invasive/multimodal therapy; Grade II-III catheters required multimodal and invasive therapies. The presence of AL in kidney increased the number of surgical interventions performed in Grade I/II catheters (p < 0.05) and the likelihood of requiring multimodal (Grade I: 90%, Grade II: 83.3%, Grade III: 100%) or invasive surgery (Grade I: 38.1%, Grade II 58.3%, Grade III 90.9%) to achieve successful treatment.

Conclusions: Incorporating both the calcified stent characteristics and the presence of AL, GARSA score can be used to determine the selection of the optimal surgical approach for patients with encrusted stents.