Management of forgotten double J stent and its complications: a single center experience
DOI:
https://doi.org/10.18203/2349-2902.isj20233337Keywords:
Forgotten Dj stent, Lithotripsy, Ureterorenoscopy, Cystolithotrity, EndourologyAbstract
Background: The objective of this study is to elaborate presenting symptoms related to forgotten ureteric double J stent, various complications related to it, it's management and possible preventive measures by which morbidity related to forgotten double j stent can be avoided
Methods: Total 30 patients admitted in our institution from January 2018 to December 2022 with double j stent in situ with more than 6 months without any indication of prolonged stenting have been included. Retrospectively analysed the collected data from the institutional records.
Results: Mean age was 42.9±12.4 yrs (18-70 yrs), mean indwelling time was 41±12.4 months (9 months to 11 yrs), Post ureterorenoscopic lithotripsy stenting was most common indication in 10 (33.3%) and most common presenting symptom was flank pain with storage lower urinary tract symptoms in 18 (60%) patients. The 22 (73.3%) patients had moderate to severe encrustation, 6 (20%) patients had fragmentation of stent and 1 (3.33%) patient had ipsilateral non-functioning kidney as one of the most feared complications. Per-cutaneous nephrolithotomy was single most employed modality of management in 15 (50%) patients, while 8 (26.67%) patients required multimodality treatment. The indwelling time and degree of encrustation showed positive strong correlation with parson correlation coefficient 0.973 which was statistically significant (p=0.014).
Conclusions: With prolonged indwelling double J stents may produces some serious complications which may require multimodality approach to treat. Such conditions can be reduced via proper patient's education and counselling.
References
Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long- term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967;97:840-4.
Singh I, Gupta NP, Hemal AK, Aron M, Seth A, Dogra PN. Severely encrusted polyurethane ureteral stents: management and analysis of potential risk factors. Urology. 2001;58(4):526-31.
El-Faqih SR, Shamsuddin AB, Chakrabarti A, Atassi R, Kardar AH, Osman MK, et al Polyurethane internal ureteral stents in treatment of stone patients: morbidity related to indwelling times. J Urol. 1991;146:1487-91.
Bultitude MF, Tiptaft RC, Glass JM, Dasgupta P. Management of encrusted ureteral stents impacted in upper tract. Urology. 2003;62:622-6.
Monga M, Klein E, Castañeda-Zúñiga WR, Thomas R. The forgotten indwelling ureteral stent: A urological dilemma. J Urol. 1995;153:1817-9.
Pal R, Kalra Y, Biswas M. Forgotten DJ. Stent: a retrospective study. International J Res Rev. 2019; 6(12):476-80.
Ali N, Somarendra K, Ali A. Forgotten Double-J Stent: Evaluation and Management in a Tertiary Hospital in the North East India. Int J Sci Stud. 2021;9(9):103-8.
Damiano R, Oliva A, Esposito C, DeSio M, Autorino R, Armiento M. Early and late complications of double pigtail ureteral stent. Urol Int. 2002;69:136-40.
Patil S, Raghuvanshi K, Jain DK, Raval A. Forgotten ureteral double - J stents and related complications : a real - world experience. Afr J Urol. 2020;4:8.
Gupta R, Gupta A, Anand A, Azad T. Stent a Nagging Problem Management and Long Term Follow. JK Sci. 2019;19(2):110-4.
Leibovici D, CooperA, LindnerA, Ostrowsky R, Kleinmann J, Velikanov S, et al. Ureteral stents: Morbidity and impact on quality of life. Isr Med Assoc J. 2005;7:491-4.
Ahallal Y, Khallouk A, El Fassi MJ, Farih MH. Risk factor analysis and management of ureteral double-J stent complications. Rev Urol. 2010;12:e147-51.
Vanderbrink BA, Ardeshir R. Rastinehad. Encrusted Urinary Stents: Evaluation and Endourologic Management. J Enourol. 2008;22:5-7.
SohrabA,Aneesh S, Sureka SK,Varun M, Nitesh P, Manoj K, et al. Forgotten reminders: An experience with managing 28 forgotten double-J stents and management of related complications. Indian J Surg. 2015;77:1165-71.
Wollin TA, Tieszer C, Riddell JV. Bacterial biofilm formation, encrustation and antibiotic adsorption to ureteral stents in dwelling in humans. J Endourol. 1998;12:101-11.
Robert M, Boularan AM, El Sandid M. DoubleJ ureteric stent encrustations: Clinical study on crystal formation on polyurethane stents. Urol Int. 1997;58: 100-3.
Takashi K., Hiroki Ito, Hideyuki Terao. Ureteral Stent Encrustation, Incrustation, and Coloring: Morbidity Related to Indwelling Times. J Endourol. 2012:26:213-4.
Shandera KC. Minimally invasive management of the calcified ureteral stent. Tech Urol. 1997;3(1):54-7.
Kumar M, Aron M, Aggarwal AK. Stenturia: An unusual manifestation of spontaneous ureteral stent fragmentation. Urol Int. 1999;62(1):114-6.
El-Sherif A. Fracture of polyurethrane double pigtail stents: an in vivo retrospective and prospective fluoroscopic study. Br J Urol. 2008;76:108-14.
Mistry K, Pal P, Chitale S. A simple two stage 'BailOut' technique for the removal of an unyielding ureteric stent. Urology. 2013;82:242-4.
Sancaktutar AA, Söylemez H, Bozkurt Y, Penbegül N, Atar M. Treatment of forgotten ureteral stents: How much does it really cost? A cost-effectiveness study in 27 patients? Urol Res. 2012;40:317-25.
Lynch MF, Ghani KR, Frost I, Anson KM. Preventing the forgotten ureteral stent: Implementation of a web-based stent registry with automatic recall application. Urology. 2007;70:423-6.
