22 years forgotten ureteral stent without encrustation; report of a case
Seyed Mohammadreza Rabani; Associate Professor of Urology and Renal Transplantation ;Beheshti Teaching Hospital; Yasuj University of Medical Sciences; Yusuj; Iran; firstname.lastname@example.org; 00989177411389
Seyed Mohammadreza Rabani; Associate Professor of Urology and Renal Transplantation; email@example.com
Background: Ureteral stents are a group of catheters which are used for preserving the patency of the ureteral lumen and they are widely used in urologic daily practices. Parallel to their life saving benefits, may have troublesome complications such as encrustation. The duration of a stent to be in the ureter depends on many related factors but finally this duration is limited. Hereby we report a case of forgotten stent without encrustation that to our knowledge it is the most prolonged forgotten stent (figure 1).
The patient is a 46 years old lady that presented with left flank pain. She had history of left side open nephrolithotomy in kazeroon when she was a child; again she underwent reoperation in Shiraz 22 years before admission to our hospital. Ultrasonography revealed left side hydronephrosis with dilatation of proximal ureter and thinning of cortex. A KUB X.Ray showed multiple left renal stones and a proximal ureteral stone (figure 2). The patient was scheduled for transurethral lithotripsy (TUL). Ureteroscopy was done by a rigid 8 - 9.8F ureterscope and stone access was done. Pneumatic lithotripsy was started but a large stone fragment escaped upward in the dilated ureter toward the kidney. It was followed where a convoluted catheter was seen in the renal pelvis. The catheter was clear, intact and without encrustation. It was grasped by a foreign body forceps and removed. The patient was not aware of this forgotten stent.
Discussion: Ureteral stents are widely used in urologic daily practices and they have proved to be an invaluable tool in the field of urology. These stents are indicated in selected cases of TUL, after surgical ureteral repair (like pyeloplasty, uretero-ureterostomy and ureteroneocystostomy). Also they can be used in renal transplantation and benign and malignant gynecologic surgeries. Parallel to their benefits they may have troublesome and even life threatening complications that depend on the duration of indwelling, stent composition and possibly the urinary tract situation (1). The reporting stent is a part of a feeding tube that was inserted during a redo nephrolithotomy and was forgotten for a period of 22 years. To our knowledge this is the most prolonged forgotten stent without encrustation that have ever been reported.
Figure 1: The clear, intact forgotten stent
Figure 2: KUB x ray with multiple renal stones and proximal ureteral stone