Intraluminal, pneumatic lithotripsy for the removal of encrusted urinary catheters

Purpose: Urologists frequently treat patients requiring long-term urinary d rainage with a percutaneous nephrostomy tube or ureteral stent. When such t ubes are neglected and become encrusted, removal challenges even experience d urologists. We describe a new, minimally invasive technique for safely an d rapidly removing encrusted, occluded tubes using the Swiss Lithoclast dag ger pneumatic lithotriptor. Materials and Methods: Patients presenting with an encrusted urinary cathet er were evaluated by excretory urography for renal function and obstruction . Gentle manual extraction of the tube was attempted, followed by tradition al extracorporeal shockwave lithotripsy and/or ureteroscopy. When the tube was not extracted, patients were then treated with intraluminal insertion o f a pneumatic Lithotripsy probe. Results: One patient presented with an encrusted, occluded nephrostomy tube and 2 had an encrusted, occluded, indwelling ureteral stent. None was remo ved by manual traction. Intralulminal encrustations prevented the pigtail p ortions of these tubes from uncoiling and removal. In each case a pneumatic lithotripsy probe was inserted into the lumen of the catheter and advanced in a jackhammer-like fashion. This technique resulted in disruption of the intraluminal encrustations and straightening of the tubes so that they wer e removed in an atraumatic manner. Conclusions: Intraluminal pneumatic lithotripsy is a safe, easy and rapid t echnique for removing encrusted urinary catheters. It is unique in that the pneumatic lithotripsy probe functions in an aqueous and nonaqueous environ ment, and dislodges intraluminal calcifications. We recommend its use as fi rst Line treatment for removing encrusted urinary catheters.