Retrieval of proximally migrated double J ureteric stents in children using goose neck snare

The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES): A novel technique for the intraureteric assembly of a loop snare for the retrograde extraction of a migrated ureteric stent

Background:

While ureteric stent removal remains a frequently performed endourological procedure stent migration either proximally or distally can present the endourologist with a significant intraoperative dilemma. In cases where the stent is of large calibre or impacted into the mucosa of the ureter, retrieval may prove refractory to traditional approaches.

Objective:

To present a further novel procedure: The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES) which allows for intraureteric assembly of a tightening loop through a ureteric catheter thus permitting safe retrieval of a migrated stent.

Methods:

We describe the procedure as it was performed and have recreated the steps in a laboratory environment. This demonstrates an adaptation of existing materials readily found in most urological theatres and is not a prototypical device.

Results:

The procedure was successfully performed to allow extraction of the migrated ureteric stent.

Conclusion:

WHISTLES is a reproducible method for the retrieval of migrated ureteric stents where traditional techniques have failed.

Level of evidence:

5

Management of proximal migration of double-J stents after Anderson-Hynes pyeloplasty in children

INTRODUCTION

Proximal migration of double J stents after pediatric pyeloplasty is rare. Although retrograde removal of migrated stents is more common, the small calibre of the pediatric ureter may necessitate antegrade retrieval. Many techniques are described for the same in adults however, pediatric literature is sparse. We aim to describe the management of proximally displaced stents after pediatric pyeloplasty.

MATERIALS AND METHODS

This retrospective study included all children (<17 years age) who underwent retrieval of proximally displaced DJ stents after pyeloplasty between 2007 and 2019 at a single institution. The retrograde technique employed ureteroscopic retrieval with a grasper while in the antegrade technique, an access sheath was placed percutaneously into a calyx and Nephroscopic retrieval was performed.

RESULTS

There were 8 children (6 boys and 2 girls) of which 4 were infants. Median age was 3.5 (0.5-12) years and median follow-up was 7.5 (4-47) months. Two children had been referred with displaced stents after pyeloplasty from other centres. The incidence of proximal stent migration was 6/1644 (0.4%). Open pyeloplasty had been performed in seven while one child had undergone laparoscopic pyeloplasty. The lower coil of the migrated stent was in the renal pelvis in 6 (complete) and ureter in 2 (partial migration). Those with partial migration underwent successful ureteroscopic retrieval. Three infants required Antegrade stent removal while ureteroscopic retrieval was successful in an older child with complete stent migration. Nephrectomy for loss of function and redo pyeloplasty for pelvi-ureteric stricture was performed in one each. One child had self-limiting fever (Clavien 1) after stent removal. All had normal drainage on renogram after 6 months. The cause of proximal stent migration was likely to be an inadequate lower coil (<180°) in 5 children and a capacious pelvis with narrow ureter in one infant. The cause could not be ascertained in two children who were referred from other centres. The management algorithm for retrieval of proximally migrated DJ stents, is depicted in Fig. 3.

CONCLUSIONS

Proximal migration of DJ stent after pyeloplasty is a rare complication which may be safely managed with a stepwise approach using both Antegrade and retrograde techniques. Accurate stent length, adequate distal coil and appropriate placement are essential to avoid stent migration.

Ureteral stent complications - experience on 50,000 procedures

Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed to evaluate an important number of procedures, the complications of ureteral stents, and their prevention and treatment retrospectively. We evaluate 50,000 procedures performed between 1996 and 2021 on 36,688 patients. According to the stenting duration, the cases were divided into short-term (less than 6 weeks – 34,213 procedures), respectively long-term stenting (more than 6 weeks – 15,757 procedures). The indications of stenting for both groups were noted. The total number of complications was 41,369. We encountered 153 cases (0.3%) of JJ stent malposition, of which 3 cases were into the retroperitoneum, one case with parenchymal perforation and hematoma. Considering the double J migrations, we found proximal migration in 427 cases (0.9%) and distal double J migrations in 352 (0.7%) cases. The obstruction of the ureteral stent, causing inefficient drainage, was encountered in 925 cases, while irritative bladder symptoms occurred in 16,326 cases (32.7%). Hematuria was observed in 5,213 cases, in 7 cases blood transfusion being necessary. Urinary tract infection was diagnosed in 7,436 cases (14.8%). Stent encrustation and calcification occurred in 832 cases, while stent fragmentation was noted in 52 cases. Double J stent complications should be promptly evaluated and treated. Encrustation and stone formation in forgotten stents often lead to serious complications and should be managed with stent removal and combined endourological techniques.

An Extremely Rare Complication of Ureteral Pigtail Stent Placement: A Case Report

Double-J (DJ) stents are the main tools used in urological practice for prevention and treatment of obstruction. Stenting is also mandatory after complicated ureteroscopy or TUL (Transureteral Lithotripsy). Known complications are upper migration of DJ stents into the kidney and lower migration to the bladder. In a man with an impacted right lower ureteral stone, a DJ stent was placed because the ureteroscope was not passed from an intramural ureter. We reported a very rare complication of DJ ureteral stent placement with intravascular migration to the pulmonary arteries, which was removed percutaneously through the right femoral vein under fluoroscopic guidance.