Management of Urinary Stent Occlusions

Initial Management and Complications

In cases where stent replacement fails due to complete occlusion, percutaneous nephrostomy should be placed to relieve obstruction, as recommended by the American College of Radiology 1, 2
Antegrade access with conversion to a percutaneous nephroureteral stent may be required for complicated cases, according to the Journal of the American College of Radiology 3, 4
If enlarging urinoma, fever, increasing pain, ileus, fistula or infection are present, urinary drainage should be performed via ureteral stent, as suggested by the American Urological Association 2
This may be augmented by percutaneous urinoma drain, percutaneous nephrostomy, or both, as recommended by the American Urological Association 2

In patients with urinary diversion, image-guided percutaneous antegrade access with either immediate or delayed conversion to retrograde percutaneous nephroureterostomy is often preferred, according to the American College of Radiology 4
Internal double-J stents tend to occlude quickly in ileal conduits due to mucous plugging, as noted by the American College of Radiology 4