Urinary Incontinence and Urosepsis due to Forgotten Ureteral Stent

Abstract

Case report of a patient who, while being under study due to total urinary incontinence and multiple urinary tract infections, interoccurs with urosepsis due to a forgotten and encrusted double-J stent. An open surgery is performed with two surgical approaches, suprapubic and minimal lumbotomy, in which a nephrectomy of the atrophic kidney, a resection of the urether with a calcified double-J in its interior and a cystolithotomy were conducted with the resulting favorable resolution of the pathology.

Case Report: A Calculus-Free Ureteral Stent Forgotten for 29 Years

“…Nevertheless, some patients still have poor compliance and forget to return for removal (sometimes for more than 10 years). In the long term, severe complications might ensue, including stent encrustation (2-6), novel calculus formation (2, 3, 5, 7), stent migration (18), stent fragmentation (6,19,20), hydronephrosis (2,9,21), or urosepsis (10). A literature search revealed that stent encrustation and urinary stone formation are the most common long-term complications.…”

“…Ureteral stents are used in renal and ureteral calculi surgery to promote the expulsion of calculi fragments and prevent ureteral strictures. Severe complications, such as stent encrustation (2)(3)(4)(5)(6), stent migration (7), fragmentation (4), stone formation (2,5,8), hydronephrosis (9), and urosepsis (10), may appear when the stent has been left in situ for extended periods. If a ureteral stent remains for more than 6 months, the probability of migration and calculus formation of the stent increases substantially (11).…”

Forgotten Ureteral Stent Syndrome

“…In patients with the signs and symptoms described above, an X-ray of the urinary tract, blood tests and urine culture should be considered initially [29]. Urinary tract X-rays can not only confirm the existence of the stent but also show whether it is encrustated.…”

“…The degree of encrustation can be more precisely defined by performing an abdominopelvic CT scan without iodine contrast. Grades of stent encrustation are listed in the FECal Ureteral Grading System classification [2,29]:…”

“…This classification makes it possible to standardise the assessment of the extent of encrustation of stents and can guide decision-making on the treatment required [1]. Ultrasonography of the urinary tract is of interest to assess the existence or not of hydronephrosis, which may suggest obstruction and/or encrustation of the stent [29]. Assessment of the proximal end should be done with an empty bladder to avoid artefact due to excessive bladder distension.…”