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  • Review Article
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Ureteral stent-associated complications—where we are and where we are going

Nature Reviews Urology volume 12, pages 17–25 (2015)Cite this article

Subjects

Key Points

  • Ureteral stents are associated with complications including infection, encrustation, haematuria and discomfort that can be caused by tissue irritation

  • The role of bacterial adhesion and biofilm formation on stents in stent-associated UTIs is unclear and development of UTIs and their treatment might depend on patient immune status

  • Encrustation and calcification are common problems that can lead to severe complications, which can be prevented by implementing electronic systems to monitor stent dwell times

  • Metal stents are a good alternative to polymer stents in the treatment of extrinsically caused ureteral obstruction; flexible and drug-eluting metal designs could help ameliorate discomfort and stenosis, respectively

  • Biodegradable ureteral stents could avoid complications, such as encrustation, but flaws in their biocompatibility still need to be addressed

  • Future stent design will focus on biodegradable and metal stents that elute drugs to prevent complications and are engineered to treat specific urological conditions

Abstract

Ureteral stents are one of the most commonly used devices in the treatment of benign and malignant urological diseases. However, they are associated with common complications including encrustation, infection, pain and discomfort caused by ureteral tissue irritation and possibly irregular peristalsis. In addition, stent migration and failure due to external compression by malignancies or restenosis occur, albeit less frequently. As these complications restrict optimal stent function, including maintenance of adequate urine drainage and alleviation of hydronephrosis, novel stent materials and designs are required. In recent years, progress has been made in the development of drug-eluting expandable metal stents and biodegradable stents. New engineering technologies are being investigated to provide stents with increased biocompatibility, decreased susceptibility to encrustation and improved drug-elution characteristics. These novel stent characteristics might help eliminate some of the common complications associated with ureteral stenting and will be an important step towards understanding the behaviour of stents within the urinary tract.

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Figure 1: Appearance and insertion of metal stents studied for use in the ureter.

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  1. Department of Urologic Sciences, The Stone Centre at Vancouver General Hospital, University of British Columbia, Jack Bell Research Centre, 2660 Oak Street, Vancouver, V6H 3Z6, BC, Canada

    Dirk Lange, Samir Bidnur, Nathan Hoag & Ben H. Chew

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All authors researched the data for the article and provided substantial contributions to discussions of its content. D.L., S.B. and N.H. wrote the article. D.L. and B.H.C. undertook review and/or editing of the manuscript before submission.

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Correspondence to Dirk Lange.

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D.L. and B.H.C. declare consulting associations with Bard Medical, Boston Scientific, Cook Medical, Olympus and PercSys. S.B. and N.H. declare no competing interests.

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Lange, D., Bidnur, S., Hoag, N. et al. Ureteral stent-associated complications—where we are and where we are going. Nat Rev Urol 12, 17–25 (2015). https://doi.org/10.1038/nrurol.2014.340

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