Tricks and tacks in the management of the forgotten double J stent

Abstract

Background: Double J ureteral stent has become the part and parcel of the routine procedure for the prevention or relief of upper urinary tract obstruction. Forgotten DJ stent can lead to encrustation, infection, migration, hydronephrosis and fragmentation.Methods: Total 16 patients with forgotten double J stent at urology department of the tertiary teaching hospital from January 2014 to December 2016 were included in this retrospective study. The details reviewed included the indwelling time, presenting complaints, radiological and laboratory investigations, their management techniques and complications of the interventions.Results: Twelve were male while 4 were female with mean patient age was 41.3±10 years. Most common presenting complaints were lower urinary tract symptoms. Five had broken stent, two encrusted calcified stents while two were migrated to upper ureter. One patient was diagnosed as pyonephrosis while 6 patients were uncomplicated cases.Conclusions: Stents, which are forgotten, can lead to morbidity in stented patients. Stent register should be made, and a computer-based tracking system has also been described to ensure the safety.

Forgotten double J stent with maximum stone burden

“…If forgotten, DJ stents, which are indispensible in urological procedures, pose a major challenge to the attending surgeon and to the patient as well. A stent with an indwelling time period of more than 3-6 months can be termed "forgotten" if not intended by the treating doctor [7]. The reasons behind a forgotten or retained stent can be attributed to inadequate counselling by the treating doctor and poor compliance on the part of the patient and his or her family [8].…”

Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?

“…Ureteral stents are an indispensable armamentarium of the urologists both in elective and emergency surgical interventions. The removal of these stents can sometimes be “forgotten”, which can happen due to poor compliance of patients and lack of timely reminders from the treating urologists, which can be highly prevalent in resource-constrained countries [ 1 , 2 ]. A myriad of complications has been attributed to the forgotten double-J (DJ) stent, including hematuria, stent blockage, migration, encrustation, fragmentation, and stone formation [ 3 , 4 ].…”

The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES): A novel technique for the intraureteric assembly of a loop snare for the retrograde extraction of a migrated ureteric stent

“…2,[6][7][8][9] The implications of the 'forgotten stent' are documented in the literature. 10 Inadvertent placement during stone surgery has been reported. 11 One desired feature for ureteric stents is that they are easy to remove.…”

“…2,6–9 The implications of the ‘forgotten stent’ are documented in the literature. 10 Inadvertent placement during stone surgery has been reported. 11…”