https://doi.org/10.4081/aiua.2025.13991
Ascorbic acid supplementation effectiveness in reducing Double-J ureteric stent encrustations. A multicenter perspective
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 30 September 2025
Background: Double J (DJ) ureteric stent encrustation is a troublesome complication that may impede its removal. The proposed study aims to investigate the effect of ascorbic acid supplementation on reducing DJ stent encrustations and identify potential risk factors.
Methods: A multi-center, non-concurrent cohort study involved patients who had DJ ureteric stents from July 2017 to January 2024. Group I comprised 359 patients who took 500 mg of ascorbic acid supplements three times daily that continued until the time of DJ removal. In contrast, Group II consisted of 483 patients who did not use the supplement. The study groups were compared in terms of patient demographics, stone criteria, double-J stent encrustations, and stent-related adverse events. The KUB grading system for stent encrustations was utilized.
Results: The study enrolled 842 patients with a prevalence of stent encrustations of 20.43%. The mean K, U, and B scores were 2.14, 1.91, and 2.15, respectively, and the mean total K.U.B. score was 6.2 ± 2.91. The study groups were comparable in terms of patient demographics; however, nine patients (2.5%) in group I had stent encrustations, compared to 163 (33.7%) in group II, with a statistically significant difference (p<0.001). Urinary tract infections (UTIs) were more prevalent in group II at 57.8%, compared to 30% in group I (p=0.02). Lack of treatment with ascorbic acid male gender, and longer duration of indwelling stents were significant predictors of stent encrustations (p<0.05).
Conclusions: Our study has demonstrated that ascorbic acid supplementation could reduce the incidence of encrustations on double- J ureteric stents. Lack of ascorbic acid administration, male gender, and prolonged stent indwelling time were significant predictors for stent encrustations.
Downloads
1. El-Faqih SR, Shamsuddin AB, Chakrabarti A, et al. Polyurethane internal ureteral stents in treatment of stone patients: Morbidityrelated to indwelling times. J Urol. 1991; 146:1487-1491. DOI: https://doi.org/10.1016/S0022-5347(17)38146-6
2. Omer N, Garden E, Small A, Palese M. Ureteral stent encrustation: epidemiology, pathophysiology, management and current technology. J Urol. 2021; 205:68-77. DOI: https://doi.org/10.1097/JU.0000000000001343
3. Kram W, Buchholz NNP, Hakenberg OW. Ureteral stent encrustation. Pathophysiology. Arch Esp Urol. 2016; 69:485-493.
4. Grases F, Söhnel O, Costa-Bauzá A, et al. Study on concretions developed around urinary catheters and mechanisms of renal calculi development. Nephron 2001; 88:320-328. DOI: https://doi.org/10.1159/000046015
5. Bithelis G, Bouropoulos N, Liatsikos EN, et al. Assessment of encrustations on polyurethane ureteral stents. J Endourol. 2004;18:550-556. DOI: https://doi.org/10.1089/0892779041783492
6. Bouzidi H, Traxer O, Doré B, et al. Characteristics of encrustation of ureteric stents in patients with urinary stones. Prog Urol. 2008;18:230-237. DOI: https://doi.org/10.1016/j.purol.2008.02.004
7. Beysens M, Tailly TO. Ureteral stents in urolithiasis. Asian J Urol. 2018;5:274-286. DOI: https://doi.org/10.1016/j.ajur.2018.07.002
8. Small A, Thorogood S, Shah O, Healy K. Emerging mobile platforms to aid in stone management. Urol Clin N Am. 2019;46:287-301. DOI: https://doi.org/10.1016/j.ucl.2018.12.010
9. Ibilibor C, Grand R, Daneshfar C, et al. Impact of retained ureteral stents on long-term renal function. Urol Pract. 2019;6:107-111.
10. Cao Z, Zhao J, Yang K. Cu-bearing stainless steel reduces cytotoxicity and crystals adhesion after ureteral epithelial cells exposing to calcium oxalate monohydrate. Sci Rep. 2018; 8:14094. DOI: https://doi.org/10.1038/s41598-018-32388-0
11. Huang J, Wu W, Zhang S, et al. Characteristics of Double-J stent encrustations and factors associated with their development. Urol J. 2021;19:22-27.
12. Patil S, Magdum P, Shete J, et al. Forgotten DJ stent-A source of morbidity: Is stent registry a need of the hour. Int J Recent Sci Res. 2015; 6:2674-6.
13. Torrecilla C, Fernández-Concha J, Cansino JR, et al. Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a multicenter, placebo controlled, double blind, randomized clinical trial. BMC Urology. 2020; 20:1-12. DOI: https://doi.org/10.1186/s12894-020-00633-2
14. Noureldin YA, da Silva A, Fahmy N, Andonian S. Is it safe to prescribe ascorbic acid for urinary acidification in stone-forming patients with alkaline urine? Turk J Urol. 2017; 43:183-188. DOI: https://doi.org/10.5152/tud.2017.02700
15. Murphy FJ, Zelman S. Ascorbic acid as a urinary acidifying agent: 1. Comparison with the ketogenic effect of fasting. J Urol. 1965; 94:297-299. DOI: https://doi.org/10.1016/S0022-5347(17)63619-X
16. Arenas JL, Shen JK, Keheila M, et al. Kidney, ureter, and bladder (KUB): a novel grading system for encrusted ureteral stents. Urology. 2016; 97:51-55. DOI: https://doi.org/10.1016/j.urology.2016.06.050
17. Acosta-Miranda AM, Milner J, Turk TMT. The FECal double-J: a simplified approach in the management of encrusted and retained ureteral stents. J Endourol. 2009; 23:409-15. DOI: https://doi.org/10.1089/end.2008.0214
18. Kawahara T, Ito H, Terao H, et al. Ureteral stent encrustation, incrustation, and coloring: morbidity related to indwelling times. J Endourol. 2012; 27:506. DOI: https://doi.org/10.1089/end.2012.0640
19. Kadihasanoglu M, Kilciler M, Atahan O. Luminal obstruction of double J stents due to encrustation depends on indwelling time: a pilot study. Aktuelle Urol. 2017; 48:248-51. DOI: https://doi.org/10.1055/s-0042-118050
20. Singh V, Srinivastava A, Kapoor R, Kumar A. Can the complicated forgotten indwelling ureteric stents be lethal? Int Urol Nephrol 2005;37:541-546. DOI: https://doi.org/10.1007/s11255-004-4704-6
21. Ather MH, Talati J, Biyabani R. Physician responsibility for removal of implants: the case for a computerized program for trackingoverdue double-J stents. Tech Urol. 2000; 6:189-92.
22. Marangella M, Bruno M, Cosseddu D, et al. Prevalence of chronic renal insufficiency in the course of idiopathic recurrent calcium stone disease: risk factors and patterns of progression. Nephron 1990; 54:302-6. DOI: https://doi.org/10.1159/000185884
23. Del Valle EE, Spivacow FR, Negri AL. Citrate and renal stones. Medicina. 2013; 73:363-8.
24. Gul Z, Monga M. Medical and dietary therapy for kidney stone prevention. Korean J Urol. 2014; 55:775-9. DOI: https://doi.org/10.4111/kju.2014.55.12.775
25. Abdelaziz A, Fouda W, Mosharafa A, et al. Forgotten ureteral stents: Risk factors, complications and management. Afr J Urol. 2018; 24:28-33. DOI: https://doi.org/10.1016/j.afju.2017.09.005
26. El-Kholy GEG, Keritna HKM, Salem TAM. Forgotten Double-J ureteral stents: prevalence, risk factors and complications. Egypt J Hosp Med 2019;76:3912-8. DOI: https://doi.org/10.21608/ejhm.2019.41573
27. Ryall RL et al. Urinary risk factors in calcium oxalate stone disease: comparison of men and women. Br J Urol 1987; 60:480-8. DOI: https://doi.org/10.1111/j.1464-410X.1987.tb05025.x
28. Nicar MJ, Hill K, Pak CY. Inhibition by citrate of spontaneous precipitation of calcium oxalate in vitro. J Bone Miner Res 1987; 2:215-20. DOI: https://doi.org/10.1002/jbmr.5650020308
29. Patil S, Raghuvanshi K, Jain DK, Raval A. Forgotten ureteral double-J stents and related complications: a real-world experience. African Journal of Urology. 2020; 26:1-5. DOI: https://doi.org/10.1186/s12301-020-0020-3
30. Kehinde EO, Rotimi VO, Al-Awadi KA, et al. Factors predisposing to urinary tract infection after J ureteral stent insertion. J Urol. 2002; 167:1334-7. DOI: https://doi.org/10.1016/S0022-5347(05)65294-9
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.