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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 1  |  Page : 157-159
Enigma of forgotten double J stent

Department of Surgery, Subharti Medical College Attributed Meerut, UP, India

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Date of Web Publication8-Jan-2010

How to cite this article:
Niranjan A, Agarwal N, Agarwal V, Srivastava A. Enigma of forgotten double J stent. Saudi J Kidney Dis Transpl 2010;21:157-9

How to cite this URL:
Niranjan A, Agarwal N, Agarwal V, Srivastava A. Enigma of forgotten double J stent. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2022 Aug 18];21:157-9. Available from: https://www.sjkdt.org/text.asp?2010/21/1/157/58795
To the Editor,

The double J ureteral stent (DJ Stent) has be­come a boon for endoscopic as well as open urological surgery. The stent allows good uri­nary drainage from kidney to the bladder and is usually well tolerated by the patient. How­ever, different complications may occur with short or long-term use of these stents. These complications may be of minor nature such as hematuria, dysuria, frequency, low back ache and suprapubic pain or may be more major such as vesicoureteric reflux, migration, encrus­tation, urinary tract infection (UTI), stent frac­ture and secondary vesical calculus formation. [1] Herewith, we report on a rare case of for­mation of large secondary vesical calculus in a patient, in whom the DJ stent had migrated from ureter to the urinary bladder and re­mained in situ for more than 12 years.

A 42-year-old female patient presented with symptoms of recurrent UTI and suprapubic pain. She received irregular antibiotics and uri­nary alkalizer by a local general practitioner. Her past history revealed that she had under­gone left pyelolithotomy with DJ stenting about 12 years earlier. Despite the suggestions for stent removal by her previous surgeon, she ignored the advice. Radiological investigations disclosed a coiled DJ stent with encrustation in the urinary bladder [Figure 1]. Other hemato­logical and biochemical parameters were with­in normal limits. The patient was posted for suprapubic cystolithotomy under regional anes­thesia. The vesical calculus encrusted around the coiled DJ stent was removed [Figure 2]A and B and the post-operative period was un­eventful. This was a classical case of "forgotten" DJ stent migration, which formed a nidus for secondary vesical calculus formation.

Secondary vesical calculus is formed in in­fected urine and it needs a nidus for its for­mation. In the treatment of nephroureteral li­thiasis, the DJ ureteral stent is playing a won­derful role ever since it was first introduced in 1967. [2] Because of good urinary drainage from kidney to urinary bladder and good tolerance by the patient, minor complications that may occur are generally overlooked by the sur­geons. As UTI is a common entity encountered in women, serious thought to the presence of stent was not given in this patient.

In a study of 110 stented kidneys, where the stents were kept in situ for different periods, Ringel A et al [3] observed that the total compli­cation rate was up to 32.7% and in 8.2% of the cases, the stents had migrated. In this study, the late complications of ureteral stents were frequent and it appeared almost in one third of patients. In another study, Damiano R et al [4] observed flank pain in 25.3%, encrustations in 21.6%, irritative bladder symptoms in 18.8%, hematuria in 18.1%, fever more than 104°F in 12.3% and stent migration in 9.5% of the patients. They also reported that morbidity and complications were minimal when the stent was left in situ for less than three months, but longer duration of stent retention was asso­ciated with increased frequency of encrusta­tions, infections, calculus formation and obs­truction of the stented tract. Hao P et al [5] eva­luated 2685 cases of DJ stent for different nephroureteric conditions and concluded that these stents are a safe and useful adjunct for both endoscopic and open procedures, if it was kept in situ for less than 28 days.

The available literature shows that DJ stent had been missed for a maximum of eight years [6],[7] and in most cases, the stent had frag­mented spontaneously. [8],[9] In our case, the stent was in the urinary tract for 12 years after open surgery and it had migrated to the urinary bladder, where it acted as a nidus for the formation of secondary vesical calculus. Our report suggests that, since the stent is a foreign body; it should not be kept inside the body for a long period. Proper attention and meticulous follow-up with good counselling to each patient is mandatory to avoid such a mishap.

   References Top

1.El Khader K. Complications of double J ureteral stents. J Urol (Paris) 1996;102(4):173­5.  Back to cited text no. 1      
2.Vallejo Herrador J, Burgoss Revilla FJ, Alvarez Alba J, et al. Double J ureteral catheter, clinical complications. Arch Esp Urol 1998;51(4):361-73.  Back to cited text no. 2      
3.Ringel A, Richter S, Shalev M, Nissenkorn I. Late complications of ureteral stents. Eur Urol 2000;38(1):41-4.  Back to cited text no. 3      
4.Damiano R, Oliva A, Esposito C, De Sio M, Autorino R, D'Armiento M. Early and late complications of double pigtail ureteral stent. Urol Int 2002;69(2):136-40.  Back to cited text no. 4      
5.Hao P, Li W, Song C, Yan J, Song B, Li I. Clinical evaluation of double pigtail stent in patients with upper urinary tract diseases: report of 2685 cases. J Endourol 2008;22(1): 65-70.  Back to cited text no. 5      
6.Ignjatovic I, Kovic IS. Trapping of double J stent in the urinary tract eight years after extracorporeal shock wave lithotripsy. Int Urol Nephrol 2000;32(1):29-31.  Back to cited text no. 6      
7.Chun-Kai C, Ching-Chia L, Hung Lung K, Yii­ Her C, Chun-Hsiving H, Ming Chen S. Double J stent forgotten for 7 years: A case report. Kaohsiung J Med Sci 2003;19(2):84-7.  Back to cited text no. 7      
8.Soyupek S, Oksay T, Koar A. Fragmentation of a forgotten double J stent and excreted with urine: Case report. Int Urol Nephrol 2003;35 (1):91-2.  Back to cited text no. 8      
9.Adsan O, Guner E, Oztiirk B, Ataman T, Cetinkaya M. Spontaneous fragmentation of a double J Stent. Int Urol Neph 1997;29(3):307-11.  Back to cited text no. 9      

Correspondence Address:
Arati Srivastava
Department of Surgery, Subharti Medical College Attributed Meerut, UP
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Source of Support: None, Conflict of Interest: None

PMID: 20061715

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