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JOURNAL BRIEFS Urology Practice: Ureteral Stent Tracking Systems: An Opportunity to Improve Endourological Care

By: Suprita R. Krishna, MD, MHA; Alejandro Abello, MD, MPH; Peter L. Steinberg, MD | Posted on: 01 Nov 2021

Krishna S, Abello A and Steinberg P: Forget forgotten stents: review of ureteral stent tracking systems. Urol Pract 2021; 8: 645.

Ureteral stents are ubiquitous in urology and can be associated with significant morbidity and complications. Previous studies have shown that the risk of stent-related complications starts increasing after 3 months of placement,1,2 and it is therefore a key tenet of urological practice to remove stents or exchange them if they are meant to remain indwelling. Retained and forgotten indwelling stents can be a substantial source of morbidity, be challenging to manage and even lead to medicolegal liability.3–5 Unlike other medical devices such as total joint implants, there exist few robust, commercially available or off-the-shelf electronic medical record (EMR) based centralized tracking systems available for ureteral stents. We performed a scoping review of existing ureteral stent tracking systems worldwide, determining the impact these systems have on reducing the rate of retained stents.6

We identified 9 studies with a total of 4,581 stents placed, where ureteral stents were tracked after placement. Stent tracking systems ranged from cell phone based applications to social networking services, applications built into the EMR and manual data collection. Systems had varying features, such as a reminder function to identify patients who were overdue for stent removal. Electronic stent tracking systems were superior to paper based systems in identifying patients who were overdue for stent removal. Overall, lost or retained stent rates ranged from 1.2% to 13% in our analysis and were reduced to <1% with the use of tracking systems in most of the studies (see table).

Table 1. Outcomes of reported stent tracking studies

Study Year Method No. Stents Results
Ather et al10 2000 PC tracker app 225 12.5% of stents overdue pre-tracking, down to 1.2% in year 1 + 1.5% in year 2 after introducing tracker
Tang et al11 2008 Chart review 203 11 (5.4%) overdue for removal; 51 stents without documented removal (42 removed at other hospitals + 9 pts died with stents in place)
Divakaruni et al12 2013 Chart review 147 20 (13%) removed after designated max stent life
Molina et al13 2017 Stent tracker app on PC + smartphones 194 1 stent (0.5%) lost to followup; 9% overdue
MacNeil et al14 2017 Electronic stent register compared to no register 457 2 stents (0.4%) missed with register vs 6 (1.2%) missed without register
Wang et al15 2018 Function included in WeChat 183 0 stents (0%) forgotten; 22 (13%) delayed
Ulker et al16 2019 Smartphone app vs appointment card 90 0% lost to followup in app group vs 6.9% in group with appointment card
Javier-DesLoges et al17 2019 Chart review + tracking using Epic* 1,788 16 stents (0.9%) removed >90 days after placement
Kim et al18 2019 Electronic stent tracker linked to medical record 2,194 354 pts (16.1%) suspected of harboring forgotten ureteral stents; total of 12 pts (0.5%) actually had forgotten ureteral stents
*Epic Systems Corporation, Verona, Wisconsin.

When stents are left indwelling beyond the recommended dwell period, there is a risk of stent encrustation, stent failure and renal loss. Encrustation rates of stents in prior reports were 9.2% at 6 weeks, 47.5% at 6 to 12 weeks and 76.3% after 12 weeks.7 Patients with encrusted stents require anywhere between from 1 to 6 different endourological procedures for removal, at a cost that is 7 times more compared to timely stent removal.2,8,9 Furthermore, failure to arrange for timely followup for stent removal places the urologist at risk for litigation.5 The purpose of our study was to reiterate the effectiveness of stent tracking systems to prevent lost and retained stents, to reduce the morbidity associated with retained stents and to encourage development of centralized stent tracking software that is interoperable across different electronic medical systems.

  1. Ahallal Y, Khallouk A, El Fassi MJ et al: Risk factor analysis and management of ureteral double-J stent complications. Rev Urol 2010; 12: e147.
  2. Borboroglu PG and Kane CJ: Current management of severely encrusted ureteral stents with a large associated stone burden. J Urol 2000; 164: 648.
  3. Sherer BA and Coogan CL: The current state of medical malpractice in urology. Urology 2015; 86: 2.
  4. Sobel DL, Loughlin KR and Coogan CL: Medical malpractice liability in clinical urology: a survey of practicing urologists. J Urol 2006; 175: 1847.
  5. Childs B and Steinberg P: Medical malpractice and nephrolithiasis: U.S. appellate cases from 2001 to 2018. Urol Pract 2021; 8: 232.
  6. Krishna S, Abello A and Steinberg P: Forget forgotten stents: review of ureteral stent tracking systems. Urol Pract 2021; 8: 645.
  7. el-Faqih SR, Shamsuddin AB, Chakrabarti A et al: Polyurethane internal ureteral stents in treatment of stone patients: morbidity related to indwelling times. J Urol 1991; 146: 1487.
  8. Duty B, Okhunov Z, Okeke Z et al: Medical malpractice in endourology: analysis of closed cases from the state of New York. J Urol 2012; 187: 528.
  9. Weedin JW, Coburn M and Link RE: The impact of proximal stone burden on the management of encrusted and retained ureteral stents. J Urol 2011; 185: 542.
  10. Ather MH, Talati J and Biyabani R: Physician responsibility for removal of implants: the case for a computerized program for tracking overdue double-J stents. Tech Urol 2000; 6: 189.
  11. Tang VCY, Gillooly J, Lee EWY et al: Ureteric stent card register—a 5-year retrospective analysis. Ann R Coll Surg Engl 2008; 90: 156.
  12. Divakaruni N, Palmer CJ, Tek P et al: Forgotten ureteral stents: who’s at risk? J Endourol 2013; 27: 1051.
  13. Molina WR, Pessoa R, Donalisio da Silva R et al: A new patient safety smartphone application for prevention of “forgotten” ureteral stents: results from a clinical pilot study in 194 patients. Patient Saf Surg 2017; 11: 4.
  14. Macneil JWH, Michail P, Patel MI et al: Semi-automatic electronic stent register: a novel approach to preventing ureteric stents lost to follow up. ANZ J Surg 2017; 87: 837.
  15. Wang Y, Xu M, Li W et al: It is efficient to monitor the status of implanted ureteral stent using a mobile social networking service application. Urolithiasis 2020; 48: 79.
  16. Ulker V, Atalay HA, Cakmak O et al: Smartphone-based stent tracking application for prevention of forgotten ureteral double-J stents: a prospective study. Int Braz J Urol 2019; 45: 376.
  17. Javier-DesLoges JF, Johnson KK, Kenney PA et al: Novel use of the Epic electronic medical record platform to identify lost ureteral stents. J Endourol 2019; 33: 858.
  18. Kim TJ, Lee KS, Kim D et al: Development and validation of the Stent Tracking Algorithm Registry (STAR) for monitoring and retrieving forgotten ureteral stents. J Endourol 2021; 35: 1130.