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A 45-year-old female could not undergo transurethral stent removal because the metallic stent was embedded. Percutaneous nephrostomy provided antegrade access for controlled explantation. A stepwise multimodal plan combined traction to assess mobility, holmium:YAG laser incision to release ingrowth, and careful endoscopic scissor dissection to preserve ureteral integrity.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/nephrostomy-assisted-multimodal-removal-of-an-embedded-ureteral-metallic-stent-a-case-report/412473/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/nephrostomy-assisted-multimodal-removal-of-an-embedded-ureteral-metallic-stent-a-case-report/412473.png","ImageObject",300,407,{"name":92,"@type":93},"Alexandar","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is removal difficult for embedded metallic ureteral stents in malignant ureteral obstruction?","Question",{"text":112,"@type":113},"Prolonged stent indwelling can lead to tissue ingrowth and encrustation/embedding, making endoscopic extraction hazardous or unsuccessful.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What access method enabled safe removal in this case?",{"text":117,"@type":113},"A percutaneous nephrostomy was created to establish antegrade access for controlled removal when retrograde transurethral extraction was unsafe.",{"name":119,"@type":110,"acceptedAnswer":120},"What steps were used in the multimodal removal strategy?",{"text":121,"@type":113},"The approach used stepwise traction to evaluate mobility, holmium:YAG laser incision to release ingrowth, and endoscopic scissor dissection to preserve ureteral integrity.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},412473,1790736302,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090768658,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Review began 11/16/2025  \nReview ended 11/25/2025  \nPublished 11/30/2025  \n© Copyright 2025  \nMatsuo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98203  \nOpen Access Case Report  \nNephrostomy-Assisted Multimodal Removal of an Embedded Ureteral Metallic Stent: A Case Report  \nTomohiro Matsuo 1 , Kyohei Araki 2, Hiroyuki Honda 2, Kensuke Mitsunari 2, Ryoichi Imamura 2  \n1. Department of Urology, Nagasaki University Hospital, Nagasaki, JPN 2. Department of Urology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, JPN  \nCorresponding author: Tomohiro Matsuo, [tomo1228@nagasaki-u.ac.jp](tomo1228@nagasaki-u.ac.jp)  \nAbstract  \nIn 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 topreserve 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.  \nCategories: Other, Urology, Obstetrics/Gynecology  \nKeywords: antegrade–retrograde approach, embedded stent, holmium:yag laser, metallic stent, percutaneous nephrostomy  \nIntroduction  \nMalignant ureteral obstruction (MUO) is a common sequela of advanced malignancies and can lead to hydronephrosis, flank pain, infection, and progressive loss of renal function. Metallic ureteral stents are increasingly used to maintain urinary drainage and preserve renal function, especially when frequent exchanges are expected [1-3]. Recent evidence indicates that metallic ureteral stents provide favorable longterm patency and lower rates of migration or obstruction than polymeric double-J (DJ) ureteral stents. In a prospective Japanese multicenter cohort using the Resonance® metallic stent, the cumulative stent obstruction incidences at three, six, nine, and 12 months were 8.9%, 16.3%, 16.3%, and 18 .8%, respectively, with preservation of renal function in most patients [2] . Other series of metallic designs have reported technical or clinical success rates of approximately 65-88%, with migration rates as low as 1% and obstruction rates of 6-17%, compared with higher failure rates for polymeric stents [1,3] .  \nNevertheless, uncommon complications such as heavy encrustation and tissue ingrowth or embedding can make endoscopic removal hazardous or unsuccessful ; encrustation refers to bulky calcific deposits that accumulate on the stent surface, whereas tissue ingrowth or embedding describes incorporation of the stent into the urothelial wall by chronic inflammation and fibrosis [4] . In these difficult situations, a multidisciplinary, multimodal approach that integrates antegrade and retrograde access with holmium (Ho) :YAG laser incision and mechanical dissection has been described to facilitate definitive removal while limiting ureteral injury [5-7].  \nHere, we report a case of nephrostomy-assisted ","cbCaigxH4DIZTmYh","https://ap.wps.com/l/cbCaigxH4DIZTmYh","pdf",2413537,"English","# Abstract\n# Introduction\n# Case Presentation\n## How to cite this article","[{\"question\":\"Why is removal difficult for embedded metallic ureteral stents in malignant ureteral obstruction?\",\"answer\":\"Prolonged stent indwelling can lead to tissue ingrowth and encrustation/embedding, making endoscopic extraction hazardous or unsuccessful.\"},{\"question\":\"What access method enabled safe removal in this case?\",\"answer\":\"A percutaneous nephrostomy was created to establish antegrade access for controlled removal when retrograde transurethral extraction was unsafe.\"},{\"question\":\"What steps were used in the multimodal removal strategy?\",\"answer\":\"The approach used stepwise traction to evaluate mobility, holmium:YAG laser incision to release ingrowth, and endoscopic scissor dissection to preserve ureteral integrity.\"}]","Nephrostomy-Assisted Multimodal Removal of an Embedded Ureteral Metallic Stent - A Case Report | PDF",1790591694,15]