Percutaneous nephrolithotomy and cystolithalapaxy for a “forgotten” stent in a transplant kidney: case report and literature review

Veltman, Yevgeniy; Shields, John; Ciancio, Gaetano; Bird, Vincent G.

doi:10.1111/j.1399-0012.2009.01133.x

Cited by 12 publications

(12 citation statements)

References 40 publications

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“…[1][2][3][4] The long-term sequelae from ''forgotten'' stents, which include occlusion, encrustation, fragmentation, extrusion, abscess formation, renal failure, and sepsis, carry even greater morbidity and costs. [5][6][7][8] To date, the majority of the urologic literature has focused on the complex management of these forgotten stents, often with multiple endourologic approaches and necessitating more than one session. Several studies have also evaluated potential preventive measures including paper and electronic stent registers and electronic reminders.…”

Section: Introductionmentioning

confidence: 99%

Forgotten Ureteral Stents: Who's at Risk?

Divakaruni

Palmer

Tek

et al. 2013

Journal of Endourology

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The sequelae from forgotten stents carry significant morbidity and costs. In this study, we attempt to identify potential risk factors that may make patients less likely to follow up for stent removal so that more effective prevention efforts may be directed at these persons. A single-institution retrospective analysis of 187 consecutive patients who had stents placed between January 2010 and December 2010 was performed. Chart review was conducted to see if patients had undergone stent removal beyond the intended maximal stent life (MSL). Patients who were lost to follow-up were contacted to determine if stents were overdue. Logistic regression was performed to determine risk factors. Of the 187 patients who had stents placed, 147 had the stent removed before MSL and 28 had stents removed after the MSL. Twelve patients could not be contacted and were excluded from the analysis. Within our cohort of 175 patients, 48% were males, 73% were minorities (33% Latino, 30% Black, 8% Asian, and 2% Native American), 39% did not speak English, 79% were unemployed, 73% were uninsured, and 35% were married. Among the patients with forgotten stents, 68% were male, 64% were minorities (32% Latino, 29% Black, 4% Native American, and 0% Asian), 82% were unemployed, 39% did not speak English, 93% were uninsured, and 43% were married. Multivariate regression analysis demonstrated that uninsured patients (odds ratio [OR], 6.3; 95% confidence interval [CI], 1.4-28.2; P value 0.01) and males (OR, 2.8; CI, 1.2-6.8; P=0.02) had statistically significant associations with forgotten stents. Men were 2.8 times more likely to have forgotten stents than females. Patients without health insurance were six times more likely to have forgotten stents than patients with insurance. As efforts are made to prevent forgotten stents, increased attention should be given to these higher-risk patient populations.

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Section: Introductionmentioning

confidence: 99%

Forgotten Ureteral Stents: Who's at Risk?

Divakaruni

Palmer

Tek

et al. 2013

Journal of Endourology

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“…All previously reported cases have involved treatment with a combination of percutaneous nephrolithotomy (PCNL) and retrograde endoscopic removal with or without the use of a laser [10,11,12,13,14,15,16]. We report the first use of the combination of ESWL and ureteroscopic laser treatment for the forgotten stent in the transplant kidney.…”

Section: Resultsmentioning

confidence: 99%

Successful Endourological Management of the ‘Forgotten' Stent in a Transplanted Kidney

Lim

Deng

et al. 2014

Urol Int

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Background: Ureteric stents are used to prevent urological complications like ureteric fistulas and obstruction in kidney transplants. Despite its advantages, complications arising from delayed removal of a double J (DJ) stent include urinary tract infections, stone encrustation, and migration of the DJ stent [Sansalone et al.: Transplant Proc 2005;37:2511-2515]. Encrustation of the stent makes removal difficult and risks injury to the transplanted kidney. Case Presentation: We report a case of retained DJ stent for 19 years presenting with recurrent urinary tract infections. A radiograph revealed a retained ureteric stent extending from the right iliac fossa transplant kidney to the urinary bladder with multiple foci of large calcification along its length. Two sessions of extracorporeal shockwave lithotripsy along the stent were performed after a percutaneous nephrostomy tube had been placed in the transplanted kidney. Subsequently, the retained DJ stent was removed endoscopically after laser lithotripsy to remnant calcifications. Remnant stone fragments were removed with another session of ureteroscopy and laser lithotripsy. The patient achieved complete stent and stone clearance with a functioning graft. Conclusion: This case illustrates that significant stone encrustation of the retained stent in a transplanted kidney can be treated successfully with a combination of endourological techniques.

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“…Some authors used one or more of methods such as ESWL, URS, laser lithotripsy, PCNL, chemolysis with various agents by inserting PCNL tube and open surgical methods. 3,7,8,9 In our first case, we primarily applied ESWL, URS and laser lithotripsy and treatment PCNL was performed in another session. In the second case; first we performed ESWL.…”

Section: Discussionmentioning

confidence: 99%