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Forgotten and fragmented ureteral j stent with stone formation: combined endoscopic management doi: 10.1590/S1677-5538.IBJU.2014.0536 Volkan Sen 1, Halil Ibrahim Bozkurt 1, Tarık Yonguc 1, Ozgu Aydogdu 1, Serkan Yarimoglu 1, Tansu Degirmenci 1, Suleyman Minareci 1 1 Izmir Bozyaka Research and Training Hospital Department of Urology, Izmir, Turkey ABSTRACT Objective: Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis. CASE A 60 year old male patient presented with right flank pain, hematuria and dysuria. One year earlier he had a story of indwelling ureteral J stent and extracorporeal shock wave lithotripsy (ESWL) for 1 cm right ureteral stone. The patient developed an anal abcess and this diverted his attention from the retained ureteral J stent and stone. Therefore he left out ESWL therapy after two sessions and ureteral J stent was not removed. He had pyuria in his urine test and urine culture revealed Enterecoccus faecalis infection sensitive to ampicillin. Intravenous urography showed fragmented ureteral J stent to four pieces with stone formation around. One piece of the stent was in bladder, two pieces were in ureter and the last piece was in the lower pole of the kidney. Intravenous antibiotics were given until urine culture was negative. One week later vesical and ureteral fragments were removed by endoscopic cystolithotripsy and ureterolithotripsy. Renal fragment was removed via percutaneous access at the same session. The total operative time was 150 minutes and the estimated blood loss was 100 ml. Postoperative period was uneventful, the percutaneous nephrostomy tube was removed on the postoperative 1st day and the patient was discharged on the postoperative 2nd day. CONCLUSIONS Combination of endoscopic methods is minimally invasive, safe and viable treatment option in patients with forgotten and fragmented ureteral stents with stone formation. However patients should be informed in detail about the ureteral stent complications, so that these complications can be prevented. ARTICLE INFO Available at: www.brazjurol.com.br/videos/may_june_2015/Sen_602_603video.htm _____________________
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Editorial Comment This video nicely demonstrates a combined endourologic approach for a challenging problem. Stent encrustation increases as time passes. El-Faqih et al. reported that 47.5% of stents removed between 6 weeks and 12 weeks, and 76.3% of stents removed after 12 weeks developed encrustation (1). Forgotten stents that have been left in place over long periods of time can become completely encrusted. These extensively encrusted stents often require multiple procedures for their complete removal (2). Electronic stent registries have been shown to help keep track of previously placed stents (3). REFERENCES
Hubert S Swana, MD
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