|Year : 2004 | Volume
| Issue : 2 | Page : 187-188
Iatrogenic secondary urolithiasis: A case report
Rajesh Khanna, SK Gupta, P Madhusoodanan, AS Sandhu, T Sinha, A Kumar, GS Sethi, A Srivastava
Department of Urology, Army Hospital (Research and Referral), Delhi Cantt, India
Department of Urology, Army Hospital (Research and Referral), Delhi Cantt - 110 010
Source of Support: None, Conflict of Interest: None
Keywords: Foreign body, secondary urolithiasis.
|How to cite this article:|
Khanna R, Gupta S K, Madhusoodanan P, Sandhu A S, Sinha T, Kumar A, Sethi G S, Srivastava A. Iatrogenic secondary urolithiasis: A case report. Indian J Urol 2004;20:187-8
|How to cite this URL:|
Khanna R, Gupta S K, Madhusoodanan P, Sandhu A S, Sinha T, Kumar A, Sethi G S, Srivastava A. Iatrogenic secondary urolithiasis: A case report. Indian J Urol [serial online] 2004 [cited 2019 Sep 15];20:187-8. Available from: http://www.indianjurol.com/text.asp?2004/20/2/187/20764
| Case Report|| |
A 32-year-old lady, an old case of pelviureteric junction (PUJ) obstruction with renal calculi (left) had undergone an Anderson Hyne's pyeloplasty with pyelolithotomy in February 1993, where a Foley catheter was placed as a nephrostomy. She now presented in February 2003 with complaints of left flank pain with intermittent haematuria and burning micturition of 6 months duration.
General, systemic and abdominal examinations were normal. Routine hematological and biochemical investigations were normal. Urine cultures grew Klebsiella pneumoniae, sensitive to ciprofloxacin and nalidixic acid. X-ray KUB revealed a 6 cm left renal calculus [Figure - 1]. Ultrasonography of KUB showed hydronephrosis with a renal calculus. Intravenous urogram confirmed hydronephrosis with a large left renal calculus occupying the entire pelvis and a poorly functioning left kidney.
She was taken up for percutaneous nephrolithotomy.
During stone fragmentation with a Swiss lithoclast a 4 mm, intact, Foley catheter tip was visualized in the center of the stone [Figure - 2]. Complete stone clearance was achieved. The patient made an uneventful recovery and remains asymptomatic.
| Comments|| |
Foreign body calculi are a distinct, though uncommon, clinical entity. Though most foreign body calculi result from self-insertion of an unusual variety of objects into the urinary system, a large number are of iatrogenic causation. Removal of the foreign body and its associated stone can fortunately "cure" the patient.  The factors required for inducement of such stones have been extensively reviewed.  Especially significant among these are that stones can develop on foreign bodies even in the absence of infection, although the presence of urea splitting organisms enhances the process. Urinary acidification and dilution inhibit foreign body stone fottnation.
The plethora of foreign bodies reported from the urinary tract, include an extensive list of remarkable material from fountain pens to bootlaces and crayons to sewing needles. Some unusual foreign bodies include grenade and even rubber fragments. More explainable agents are parts of urethral catheters, nephrostomy tubes and surgical needles. Nonabsorbable sutures and staples should not be used in the urinary tract as they promote urolithiasis. 
Stones secondary to the presence of a foreign body within the urinary tract occur rarely. Especially rare are foreign body calculi in the kidney. An extensive net search did not reveal any such case reported. However, they should be considered in the differential diagnosis of urolithiasis as they represent a completely `curable' variety of urinary calculus disease.
| References|| |
|1.||Drach GW. Secondary and miscellaneous urolithiasis-medications, urinary diversions and foreign bodies. Urol Clin North Am 2000; 27(2): 269-73. |
|2.||Dalton DL, Hughes J, Glenn JF. Foreign bodies and urinary stones. Urology 1975; 6: 1. [PUBMED] |
|3.||Edlich RF, Rodeheaver CT, Thacker JG. Considerations in the choice of sutures for wound closure of the genitourinary tract. J Urol 1987; 137: 373. |
[Figure - 1], [Figure - 2]