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

Abstract

A 63-year-old male, previously treated for a ureteral tumour by a right-sided segmental ureterectomy and end-to-end anastomosis of ureteral segments, was referred to our clinic for endoscopic follow-up. During his follow-up, he was diagnosed with partial right-sided ureteral stricture which eventually progressed to complete obstruction. During the ureteroscopy, as the stenotic segment did not allow passage of an hydrophilic guidewire, an antegraderetrograde approach was decided. On the antegrade endoscopic view, a near-complete stenosis was diagnosed and a nephrostomy catheter (12 Fr) was placed. A second intervention was planned and from the nephrostomy tract, the ureteroscope was placed into the right pyelocaliceal system. The diagnostic ureteroscopy revealed a foreign object proximal to the stenotic area. Right-sided segmental ureterectomy of the stenotic segment with ureteroneocystostomy and removal of the foreign object was performed. This is the only case in literature to reveal a guidewire introducer as a ureteral foreign body. This case also highlights the importance of the fragility of the ureter, the importance of the equipment, of always being watchful during a surgery, and the importance of checking the integrity of the equipment at the end of each procedure.

Management Challenges of Ureteral Foreign Body-Clinical Vignette and Review of Literature

“…2,3 Guidewire introducer in the right proximal ureter, suprapubic catheter in the left distal ureter, embolization coil and endoscopic glue material both in the proximal ureter were revealed in 4 case studies. 1,4,6,9 The proximal ureter was the commonest site for foreign body in the review 42% (6/14) as most of the precipitating factors or previous procedures were in the vicinity of the proximal ureter and kidney. The mean indwelling time of the foreign body in the ureters was 4.3 years as Shuaibin et al reported the least duration of 12 days with a suprapubic catheter dislodged in the left distal ureters.…”

“…Other symptoms reported were flank pain, 3-5,10,11 followed by dysuria, 2,5,8,12 along with two incidental findings from imaging. 1,13 A total of 10/14 of the case reports, (Figure 3 and 4) 2,5-10,13 highlighted ureteroscopy + holmium laser fragmentation of calcification along with grasping forceps for retraction of foreign body . Li et al reported a laparoscopic left nephroureterectomy for a nonfunctioning kidney after lodging an intrauterine contraceptive device in the left distal ureter for 3 years.…”

“…Li et al reported a laparoscopic left nephroureterectomy for a nonfunctioning kidney after lodging an intrauterine contraceptive device in the left distal ureter for 3 years. 11 Case reports by Sener et al 1 and Miraliakbari et al 5 demonstrated segmental ureterectomy of the stenotic segment along with ureteroneocystostomy and removal of the foreign objects. Chen et al 9 showed a failed ureteroscopy followed by spontaneous passage of an endoscopic glue material.…”

“…[1][2][3][4] Migration or erosion of suture materials, mesh, Hemo-Lok clips, metallic clips, vascular graft materials, coils used for embolization, guidewire introducer, suprapubic catheter, intrauterine contraceptive device into the ureters have been reported in the literature. [1][2][3][4][5][6][7][8][9][10][11][12][13] In some clinical scenarios, symptoms such as flank pain, urinary tract infections, and lower urinary tract symptoms (frequency, hematuria, and dysuria) may be an indication for a foreign body erosion into the urinary tract. 3,4,9 extraction of such foreign bodies may also depend on the anatomical location, size, shape, and mobility of the object.…”

A Rare Case Mimicking Ureteral Stone or Tumor: Intraureteral Organized Debris

“…Sonrasında üreteropelvik bölgede gelişen 1 cm çapındaki taşın nedeninin, migrate olan zamk maddesinin olduğu belirlenmiştir (8). Diğer bir yayında segmental üreter rezeksiyonu ve uç uca üreter anastomozu yapılan bir hastanın, sonrasında gelişen üreter stenozunun nedeninin operasyon sırasında kullanılan ve unutulan "kılavuz tel introduser" olduğu bildirilmiştir (9). Üriner sisteme yapılan müdahaleler dışında, özellikle abdominal ve kadın doğum cerrahisi geçiren hastalarda da benzer durumlar görülebilmektedir.…”