Forgotten Double J Ureteral Stent for 10 years: A Case Report with Review of Literature

Background: Ureteral stents are a crucial part of urologic surgeries. Complications of Double J stenting (DJS) include migration, fragmentation, and encrustation. In addition, forgotten stents with encrustations and stone formations are difficult to remove. Case Presentation: We report the case of a stent “forgotten” for 10 years, which migrated downward into the proximal ureter, concomitant with multiple ureteral stones and bladder calculus. Whole encrustation of the stent was observed. The “forgotten” stent was positioned 10 years ago during right ureteral stone treatment in the Philippines. In the end, the patient underwent laser cystolithotripsy, stone elimination, ureteroscopic laser lithotripsy and stent removal. The final X-ray post-intervention revealed the absence of any stone fragment or residual DJS fragment. Conclusion: We report the longest period of forgotten DJS with maximum stone burden in the urinary system. To avoid this situation, patients should be educated regarding complications if the stent is not removed within a short period. Moreover, a computerized registry of stent placement can be used to alert the urologist when the stent ought to be removed.

Investigation of a novel gradient degradable ureteral stent in a beagle dog model

Ureteral stents are widely used in the department of urology, while the stent could result in many stent-associated complications, such as encrustation, a forgotten stent and patient discomfort. Thus, we developed a novel gradient degradable ureteral stent, which could degrade gradient in vivo, and assessed its effectiveness of the drainage, degradation and biocompatibility in a beagle dog model. In the present study, the degradation time and cytotoxicity were investigated in vitro. And the beagle dogs were inserted with a degradable stent or a biostable stent, and blood studies, liver function tests, renal function tests, urine studies, X-ray, excretory urograms and computerized tomography were performed at immediately, two weeks, four weeks and six weeks postoperative. The results showed that the drainage of the novel stent is similar to the conventional stent, while the biocompatibility and antibacterial ability of the novel stents are better than the conventional stents. The stents we developed provide an alternative for urologists and more assays would be performed in detail to assess the property of the stents.

Fate of Forgotten DJ Stent

Introduction: Double J stent is one common armamentarium used in urological procedure. It can serve both therapeutic and prophylactic function. However the use of double J stent is invariably associated with minor to some of major complications. Forgotten DJ stent is one untoward issue of stenting patient that is largely preventable and entails complex urological procedure to remove it. Methods: We performed descriptive study where data were collected prospectively from patients who have double J ureteral stent in situ after urological procedure. Stent left more than three months was defined as forgotten DJ stent. Demographic characteristics, clinic-radiological data and details of management were noted to evaluate the mode of presentation, associated complications and mode of treatment. The reason behind forgetting those stent was asked with study population and presented.Results: The total of 27 cases of forgotten DJ stent cases were recorded during period of December 2013 to January 2018. Mean age of patient was 46.6 ± 12.25 years. The longest indwelling time was 10 years. Stent syndrome was common mode of presentation followed by encrustation. Majority (92.5%) of the patients were managed with endourological approach and 26% (7) of cases required more than one modalities of treatment.Conclusions: The forgotten stent is an avoidable condition through proper patient counselling. When required the management necessitates simple cystoscopic to complex endourolgical intervention.

ERCP stent as a nidus for CBD stone: post cholecystectomy status

Obstruction of common bile duct due to a ‘Forgotten stent’ causing stone formation is a rare entity, which is usually associated with cholangitis. A much rarer presentation is our case with an ERCP stent forming a nidus for stone formation in the common bile duct without any evidence of cholangitis or bile duct obstruction. A 66-year-old female patient with a previous history of laparoscopic cholecystectomy and common bile duct stenting done 2 years back presented with vague abdominal pain, nausea and vomiting without features of jaundice or cholangitis. She was diagnosed on imaging as a case of choledocholithiasis with two stents in the common bile duct. A failed ERCP to extract the stent and relieve obstruction necessitated open choledochotomy, stents removal, common bile duct clearance and choledochoduodenostomy. The rarity of this patient with an ERCP acting as a nidus for common bile duct stones without evidence of obstruction or cholangitis is something to be documented. Although rare, these complications must always be considered and considered a possibility due to which post-operative and post-endoscopic follow up, regular check-ups and timely removal of the stents is necessary to avoid unnecessary complications or a need for repeat procedures and surgery that results in greater morbidity.

A rare complication after renal transplantation: Forgotten stent

In renal transplantation surgery, double J stents (DJS) are often used to reduce complications, protect the anastomosis between ureter and bladder, provide drainage in ureteral obstructions and enhance healing if there is an ureter injury. Urinary tract infections, hematuria and irritative voiding symptoms are the early complications of DJS. Migration, fragmantation, encrustation and rarely sepsis are among the late complications of DJS. In this report we describe a renal transplantation case whose DJS stent was forgotten because the patient did not attend the regular follow-up and noticed 5 years after surgery.