A Novel Visual - Grading for Ureteral Encrusted Stents Classification (V-GUES) to Help Decide the Endourologic Treatment.

Objective To propose a visual classification for encrusted stents to help to choose the appropriate endourologic treatment. Material and Methods A multi-center, retrospective and descriptive study was performed. A total of 140 patients with encrusted double J stents were collected from 5 different institutions. The novel Visual-Grading for Ureteral Encrusted Stents (V-GUES) classification system goes from A to D, increasing the severity of encrustation. Results Encrusted stents could be removed with a single intervention in 112 patients (86.8%). Type A and B encrusted stents could be successfully removed in all patients (100 % success). Type D stents had minor retrieval and stone-free rates (p = 0.006 and p<0.0001, respectively). Stone-free status was achieved after the first procedure in 89 patients (69%). Flexible ureteroscopy had a low success rate (77.7%) in type C stents (OR 0.21). Combined access had a 100 % success rate to retrieve type C encrusted stents and a 92.9% success rate for type D encrusted stents (OR 9.18). Type D stents were associated with more than one session needed to get the stent (OR: 0.11) and stones retrieved (OR 0.21). Conclusions The V-GUES grading system is associated with treatment success rates of encrusted stents retrieval and stone-free status. It is also associated with complications rate and the number of sessions needed to leave patients stent and stone free. The V-GUES classification could help counsel patients about the best treatment options and their outcomes. Further prospective studies will be needed to provide external validation.