Missed Double-J Ureteric Stent Presenting as a Large Stone Burden: A Case Report

Abstract

Ureteric stenting using a Double-J Stent (DJS) is one of the commonly used urological management techniques to ensure adequate drainage from the renal pelvis to the bladder. However, DJS placements are known to be associated with various consequences and complications. Hereby, the authors present a case of a 46-year-old male who presented to the Emergency Department with left flank pain and haematuria that had persisted for one week. The patient had previously undergone ureteric stenting one year prior for the management of a left ureteric calculus. Unfortunately, he had not returned for follow-up due to the Coronavirus Disease 2019 (COVID-19) pandemic. X-ray of the Kidney, Ureter, and Bladder (KUB) and Computed Tomography (CT) of the KUB revealed a missed left ureteral stent that was completely encrusted and associated with the highest stone burden. This stent was causing obstruction of the left renal pelvis-calyceal system and thinning of the left renal parenchyma. The patient also had a co-existing staghorn calculus and urinary tract infection. After completing a course of antibiotics, the encrusted ureteral stent was surgically removed using cystolitholapaxy with pneumatic lithotripsy, ureteral lithoclast, and percutaneous nephrolithotomy. A new DJS was placed to maintain drainage through the ureter. The patient had no complications during the follow-up period. Authors reported a case of a missed DJS with the highest stone burden within a year to highlight the importance of patient and family education. Authors recommended implementing electronic follow-up systems for patients who undergo ureteric stenting to prevent lost to follow-up, minimise long-term complications, and ensure patient safety.

Keywords

• lithotripsy
• patient education
• percutaneous nephrolithotomy
• postoperative complication
• stent
• urolithiasis