# Nephrostomy-Assisted Multimodal Removal of an Embedded Ureteral Metallic Stent: A Case Report

## TL;DR

A case report describes a successful method to remove an embedded ureteral metallic stent using a combination of antegrade access and laser techniques.

## Contribution

The paper introduces a nephrostomy-assisted multimodal approach for safely removing embedded metallic ureteral stents.

## Key findings

- Standard retrograde removal was unsafe due to stent embedding.
- A multimodal approach using antegrade access, laser incision, and endoscopic dissection successfully removed the stent without injury.
- The method proved effective and safe for embedded metallic stents when conventional methods fail.

## Abstract

In malignant ureteral obstruction (MUO), metallic ureteral stents are widely used to maintain urinary drainage; however, prolonged indwelling can lead to tissue ingrowth and encrustation, complicating safe removal. Here, we report a case in which standard retrograde removal was considered unsafe due to stent embedding. A female patient aged 45 years presented with a ureteral metallic stent that could not be safely removed via the transurethral route. To enable controlled removal, a percutaneous nephrostomy was created to establish antegrade access. A stepwise, multimodal strategy was employed: initial traction to evaluate mobility, holmium:YAG laser incision to release ingrowth, and careful dissection with endoscopic scissors to preserve ureteral integrity. The stent was removed en bloc without structural injury. This case demonstrates the effectiveness and safety of a nephrostomy-assisted multimodal method for embedded ureteral metallic stents. When conventional retrograde removal is unsuccessful or unsafe, combining antegrade access with traction, holmium laser release, and endoscopic scissor dissection can enable definitive explantation while limiting urinary tract injury.