Year : 2004 | Volume
: 20 | Issue : 2 | Page : 174--175
Management of a ureteral stone following a forgotten stent after transuretero- ureterostomy
Kamats Kidney Hospital, Opp. Government Press, Kothi, Baroda, India
Kamats Kidney Hospital, Opp. Government Press, Kothi Baroda - 390 001
|How to cite this article:|
Kamat N. Management of a ureteral stone following a forgotten stent after transuretero- ureterostomy.Indian J Urol 2004;20:174-175
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Kamat N. Management of a ureteral stone following a forgotten stent after transuretero- ureterostomy. Indian J Urol [serial online] 2004 [cited 2020 Mar 28 ];20:174-175
Available from: http://www.indianjurol.com/text.asp?2004/20/2/174/20753
A 35-year-old female patient was operated for transuretero-ureterostomy five years back following a ureterovaginal fistula. The left ureter was translocated to the right side. A ureteric stent was inserted into the non-translocated right side. She defaulted in follow up and the stent remained in situ for five years. Now, she presented with right flank pain and burning micturition. Plain X-ray of the kidney, ureter and bladder revealed, besides the stent, a stone on the renal coil of the ureteric stent, and a ureteric stone in the midureter [Figure 1]. The IVU sequence confirmed that the ureteric stone was at the transuretero-ureterostomy junction and was causing bilateral hydronephrosis and hydroureters [Figure 1]. A ureteroscopic removal of the ureteric stone, followed by PCNL for removal of the renal stone and the stent was planned. On initial opacification of the ureter, the ureteric stone, which was faintly radiolucent, could not be subsequently visualized on the C-arm. Assuming that the stone had migrated into the right upper ureter, because of its straight direction, a decision to go ahead with the PCNL was taken. Through a middle calyceal puncture, the renal stone was fragmented and removed, followed by removal of the stent. On searching the ureters on the C-arm, the migrated ureteric stone could be located in the left mid-ureter [Figure 2]. The 10F Storz rigid ureteroscope could be negotiated beyond the anastomotic site, into the left ureter, but the rigid scope could not cross the midline. Attempts to bring down the ureteric stone from the opposite side left ureter, into the common ulcer, failed. As the daily endoscopic inventory of our general urological department did not include a flexible ureteroscope, the procedure was abandoned. Two days later, the check Xray KUB showed that the stone had come upto the transuretero-ureterostomy junction. An ureteroscopy was again performed, keeping the availability of a flexible reteroscope, if required. With a plan to avoid migration of the stone into the opposite ureter, the stone was negotiated into the right midureter above the anastomotic site and fragmented. The stone clearance was complete and the postoperative recovery was uneventful.
Forgotten stents and their complications are not so uncommon. ,, The difficulty of dealing with this problem with conventional endoscopic equipment in a routine urological set up is highlighted. The preoperative assumption that the stone would migrate into the vertically directed right ureter proved incorrect, due to the presence of the stent in its lumen. The stone migrated into the relatively vacant diagonally placed left ureter. Locating the relatively radio-lucent stone on the superimposing spine was extremely difficult and due to this ESWL by X-ray localization was not considered. As manipulation of the rigid ureteroscope across the midline was potentially dangerous, and physically impossible, the procedure was abandoned, with the expectation that such a mobile stone, would definitely come down upto the transuretero-ureterostomy junction in a few days. Though the ureteric stone was finally removed with the conventional rigid ureteroscope, a flexible ureteroscope could have made it a lot easier to retrieve the migrated stone. Forgotten stents in an altered anatomy can demand an exceptional ingenuity on the part of the managing urologist.
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