Potassium Citrate in the Prevention of Ureteral Stent Encrustation: A Review of Mechanisms, Efficacy, and Clinical Applications

Abstract

Background: Ureteral stent encrustation is a significant complication following ureteroscopy, occurring in 9-76% of cases depending on dwell time. Mineral deposition primarily calcium phosphate, struvite, and calcium oxalate creates crystalline layers that obstruct urine flow, harbor bacteria, and complicate stent removal. Risk factors include prolonged stent duration, acidic urinary pH, metabolic abnormalities, and urinary supersaturation. Severely encrusted stents may require complex endoscopic procedures or open surgery, increasing morbidity and healthcare costs. Potassium citrate, a urinary alkalinizing agent traditionally used in kidney stone prevention, has emerged as a potential prophylactic intervention. By elevating urinary pH (6.8-7.2) and providing citrate as a natural crystallization inhibitor, it may prevent mineral deposition on stent surfaces. This review synthesizes current evidence on potassium citrate's mechanisms, efficacy, safety, and clinical application in preventing ureteral stent encrustation.