International Urology and Nephrology

, Volume 37, Issue 3, pp 541–546 | Cite as

Can the Complicated Forgotten Indwelling Ureteric Stents be Lethal?

Abstract

Introduction: The forgotten ureteral stents remain a urological dilemma and complications related to it can be lethal for the patient. The management of such stents require lithotripsy and endourological techniques. Materials and methods: We retrospectively reviewed the records of 19 cases of forgotten stents managed between 1998 and 2003. The mean patient age was 32 ± l2 years, male to female ratio 17:2 and the mean duration of stents in urinary system was 24.2 months (7 months to l0 years). The stent were complicated in 14 patients and 5 patients had uncomplicated stents. The stents were severely calcified and encrusted in 6 patients, large stone formation seen at upper end of stent in 2 patients and at lower end of stents in 2 patients. The stents were spontaneously fragmented in 2 patients. The advanced renal failure secondary to hydroureteronephrosis because of severe encrustation and stone formation over the stent in solitary kidney was seen in 1 patient and 1 patient had upmigrated stent with infected hydronephrosis, but the duration of upmigration in this case was unknown. Results: The stents were removed by retrograde approach in all 5 uncomplicated cases. In 6 patients of severely calcified and encrusted stents, the retrograde stent removal could be done in 4 patients while stent got broken in proximal ureter in 2 cases when they were being removed. In these 2 cases the stents were removed by percutaneous nephrostomy. The percutaneous nephrolithotomy and stent removal was done in 2 patients who had large stone at the upper end of stent in renal pelvis. In 2 patients who had large stone formation at lower end, stones were fragmented by mechanical lithotripsy in one and by laser lithotripsy in another case and stents removed by retrograde approach. Two cases of spontaneous fragmented stents were managed by retrograde endoscopic approach. The patient of advanced renal failure refused treatment and died. The patient of infective hydronephrosis with upmigrated stent died because of complications related to operative intervention. Conclusions: The management of complicated forgotten ureteral stents need judicious use of endourological techniques and lithotripsy. The stent related complication can be directly lethal for the patient or indirectly can cause death because of complications related to operative intervention.

Keywords

Complication Forgotten Lethal Stents Ureter 

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References

  1. 1.
    Monga, M, Klein, E, Castaneda-Zuniga, WR,  et al. 1995The forgotten indwelling ureteral stent: a urological dilemmaJ Urol15318171819PubMedGoogle Scholar
  2. 2.
    Domiano, R, Oliva, A, Esposito, C,  et al. 2002Early and late complications of double pigtail ureteral stentUrol Int69136140Google Scholar
  3. 3.
    Richter, S, Ringel, A, Shalev, M,  et al. 2000The indwelling ureterk stent: a ‘friendly’ procedure with unfriendly high morbidityBJU Int85408411CrossRefPubMedGoogle Scholar
  4. 4.
    EI-Faqih, SR, Shamsuddin, AB, Chakrabarti, A,  et al. 1991Polyurethane internal stents in treatment of stone patients: morbidity related to indwelling timesJ Uro114871491Google Scholar
  5. 5.
    Rembrink, K, Goepel, M, Meyer-Schwickerath, M. 1992The forgotten double J stent. Case report of a multifractured ureter stentUrol lnt49119120Google Scholar
  6. 6.
    Zisman, A, Siegel, YI, Siegmann, A,  et al. 1995Spontaneous ureteral stent fragmentationJ Urol153718721PubMedGoogle Scholar
  7. 7.
    Irani, J, Siquier, J, Pires, C,  et al. 1999Symptoms characteristics and the development of tolerance with time in patients with indwelling double pigtail ureteral stentBJU Int84276279CrossRefPubMedGoogle Scholar
  8. 8.
    Ringel, A, Richter, S, Shalev, M,  et al. 2000Late complications of ureteral stentEur urol384144CrossRefPubMedGoogle Scholar
  9. 9.
    Smet, G., Vandeursen, H, Baert, L. 1991Extracorporeal-shock wave lithotripsy for calcified ureteral catheterUrol Int46211212PubMedGoogle Scholar
  10. 10.
    Borboroglu, PG, Kane, CJ. 2000Current management of severely encrusted ureteral stents with large stone burdenJ urol164648650PubMedGoogle Scholar
  11. 11.
    Robert, M, Boularan, AM, Sandid, ME,  et al. 1997Double-J ureteric stent incrustations. Clinical study on crystal formation on polyurethane stentUrol Int58100104PubMedCrossRefGoogle Scholar
  12. 12.
    Breau, RH, Norman, RW. 2001Optimal prevention and management of proximal ureteral stent migration and remigrationJ urol166890893PubMedGoogle Scholar
  13. 13.
    Nicol, DL, PNg, K, Hardie, DR,  et al. 1993Routine use of indwelling ureteral stents in renal transplantationJ Urol15013751379PubMedGoogle Scholar
  14. 14.
    Saltzman, B. 1998Ureteral stents: indications, variations and complicationsUrol Clin North Am.15481491Google Scholar
  15. 15.
    Kirkali, Z, Esen, AA, Akan, G. 1993Placement of double-J ureteral stents in extracorporeal-shock wave lithotripsyEur Urol23460462PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • V. Singh
    • 1
  • A. Srinivastava
    • 1
  • R. Kapoor
    • 1
  • A. Kumar
    • 1
  1. 1.Department of Urology and Renal TransplantationSanjay Gandhi Post Graduate Institute of Medical ScienceLucknowIndia
  2. 2.Department of UrologyKing George’s Medical UniversityLucknowIndia

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