A guidewire introducer as a ureteral foreign body: A case report

Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review

Background

Foreign bodies in the kidney have rarely been reported. However, they can be a clinical problem for urologists. We report on a patient with a residual segment of guidewire coating embedded in the renal parenchyma following computed tomography (CT)-guided percutaneous nephrostomy drainage (PCND), and our successful minimally invasive management with retrograde intrarenal surgery (RIRS).

Case presentation

A 40-year-old female with urosepsis due to a right upper ureteral stone with hydronephrosis received emergent CT-guided PCND and subsequent ureteroscopic lithotripsy, double J stent insertion, and percutaneous catheter removal. Follow-up radiography showed a coiled object within the upper pole parenchyma of the right kidney, which might be the remnant of a guidewire used during the PCND procedure. Flexible ureteroscopy (fURS) was performed. Under fluoroscopy, the foreign body was localized, the renal parenchyma was incised with laser, and the foreign body was retrieved using a stone basket.

Conclusion

Although guidewire breakage is uncommon, clinicians should keep it in mind during interventional procedures. Several methods can be used to eradicate foreign objects from the urinary tract, and the first choice should always be the least invasive one. RIRS with fURS is considered as a safe, efficient, and minimally invasive option for the extraction of foreign bodies from the kidney. To the best of our knowledge, this is the first comprehensive case report detailing the removal of a foreign object by RIRS in the English literature.

An unusual retained object post laser flexible ureteroscopy (retained broken tip of disposable ureteroscope)

Flexible Ureterorenoscopy (F-URS) has dramatically changed the era of Renal stone management. One of its rare complications is retained objects. Some reports, described accidental breakage is reusable ureteroscope. Here we present 36-year-old male patient who underwent to F-URS in another institute March 2018. Four months later presented to our hospital with right flank pain. Renal Us showed mild hydronephrosis associated with 13 mm renal stones. Patient underwent F-URS, when we found the broken tip of disposable ureteroscope retained from the first operation. Urologist should always pay careful attention to the flexible ureteroscpe to check for any sign of breakage before and after the procedure.

Simultaneous Ureteral and Renal Foreign Bodies

Clinical presentation of patients with foreign bodies is highly variable. We received a 55-year-old female patient with fever and right flank pain. She was treated previously for kidney stones by percutaneous nephrolithtomy with partial resolution, requiring renal embolization during this procedure because of bleeding. CT evidenced metallic density images localized in kidney and ureter, associated with kidney stones located in lower calix. Semirigid ureteroscopy and retrograde intrarenal surgery were performed, revealing the presence of foreign bodies in both localizations and lower calix stones. Complete removal of foreign bodies and stones was performed. Foreign bodies were found to be embolization coils applied in the previous procedure.

The Use of Apnea During Ureteroscopy

OBJECTIVE

To describe and discuss the feasibility and the use of apnea during retrograde intrarenal surgery (RIRS).

MATERIALS AND METHODS

A discussion of the current literature about the different anesthesia techniques and the use of apnea to improve RIRS by avoiding renal movements over diaphragmatic excursion was performed.

RESULTS

To date, there are no mentions in the literature about the use of apnea as a mechanism to facilitate this procedure that requires extremely precise laser use. A description of the feasibility of apnea during RIRS is described as a technical consideration and discussed.

CONCLUSION

The use of apnea during RIRS has facilitated the procedure, avoiding renal movements, particularly in special cases where extremely precise maneuvers during laser use are required.