Huge encrusted ureteral stent forgotten for over 25 years: A case report

Neglected ureteral stent in a patient with chronic kidney disease and solitary functioning kidney: case report and review of literature

Introduction

A ureteral stent is crucial for managing urinary flow obstruction, ureteral reconstructive surgeries, and iatrogenic ureteral injuries. The authors aim to report a case of forgotten double-J stent for 17 years, the longest time reported in literature in a patient with solitary kidney and no typical long-term complications as stones formation and encrustation.

Case presentation

A 58-year-old male with chronic kidney disease and solitary left kidney presented with left loin pain. With creatinine higher than baseline (6.2 mg/dl), he reported a neglected double-J stent placed 17 years ago in a different hospital. In addition, non-contrast computed tomography and cystoscopy revealed hydronephrosis, cystitis, and an element of infra-vesical obstruction, evident by high bladder neck. Treatment included left percutaneous nephrostomy, but he was readmitted few weeks later for cystoscopy, ureteroscopy, and a new double-J insertion. Due to worsening renal function, he was readmitted four weeks later for cystoscopic removal of the new double-J stent and Transurethral Resection of the Prostate, after which creatinine returned to baseline.

Discussion

Double-J stents are vital in urological procedures, but neglecting their presence can lead to severe complications like encrustations, stone formation, stent fractures, hydronephrosis, infections, and renal function loss. Treatment of long-term complications is difficult and should consider many factors, including the type and severity of associated complications and the patient's preoperative status.

Conclusion

Preventing complications from neglected or forgotten double-J stents through patient education and follow-up is crucial, especially in those with solitary functioning kidneys due to the imminent loss of renal function.

Endoscopic management of encrusted ureteral stents: outcomes and tips and tricks

PURPOSE

To report our experience in the management of encrusted ureteral stents (EUS) and provide technical insight of our endourological approaches for difficult scenarios posed by this entity.

MATERIALS AND METHODS

A retrospective evaluation of a longitudinally collected database of 58 patients with encrusted US between December 2012 and May 2022 was performed. The ureteral stents were initially inserted due to obstructive uropathy, pyelonephritis or after a successful endoscopic procedure for urolithiasis. A combination of antegrade/retrograde treatment in single or multiple sessions took place for the retrieval of the encrusted stents. Non-contrast enhanced computer tomography was used for the follow-up of the patients at 1-month after the removal of the encrusted stent.

RESULTS

Overall 58 patients, 39 males and 19 females with a median age of 51 years old were included in the study. Indwelling time was < 6 months, 6-12 months and > 12 months in 22%, 57% and 21% of the cases, respectively. All US were successfully removed. Semi-rigid ureteroscopy (URS) and flexible ureteroscopy (fURS) were used in 90% of the cases. In 10% of the cases, a second-stage percutaneous nephrolithotomy (PCNL) or endoscopic combined intrarenal surgery (ECIRS) was performed. All US were successfully released. Stone-free rate was 84% at 1-month. Overall complication rate was 10.5% (mostly postoperative fevers, 5.4%).

CONCLUSION

Removal of the encrusted US is a challenging procedure. Appropriate decision-making and knowledge of specific tricks may result in safe and successful management of significant EUS.

Case Report: A Calculus-Free Ureteral Stent Forgotten for 29 Years

Ureteral stents are widely used. If ureteral stents remain in place for extended periods, the probability of migration and stone formation increases substantially. However, a 29-year-old ureteral stent that was placed and did not develop calculus is rare. We reported a 45-year-old man admitted with pain in the left side of his waist and abdomen for more than 10 years. He underwent a ureterotomy 29 years prior to admission for left ureteral calculi, and a ureteral stent was placed postoperatively to prevent ureteral strictures. The ureteral stent was not removed in the hospital due to poor compliance on the part of the patient. This left ureteral stent was not visible on computed tomography (CT) and plain films. On ureteroscopy or flexible ureteroscopy, no new calculus was found in the left ureter and kidney. No calculus was found in the stent that is usually easily removed with calculus-removing forceps. This phenomenon is rare, and it highlights the importance of follow-up.