Forgotten Ureteral Stents: An Avoidable Morbidity.

Badar Murtaza; Sarwar Alvi

Author(s)

Badar Murtaza Department of Urology, Combined Military Hospital (CMH), Sialkot, Pakistan

Sarwar Alvi Department of Urology, Combined Military Hospital (CMH), Kharian, Pakistan

Abstract

Objective: To assess the clinical presentation of forgotten ureteral stents and highlight the etiological factors resulting in the retention of these stents. Study Design: Observational study. Place and Duration of Study: Department of Urology, Armed Forces Institute of Urology, Rawalpindi, from January 2010 to June 2011. Methodology: Thirty-eight patients, with forgotten ureteral stents, retained for more than 6 months duration, were enrolled. A detailed evaluation was performed, along with the questions regarding the patients' opinion about the ureteral stents. They were specially asked whether they knew about the stents or were they formally informed regarding the stents. Subsequently, the patients were managed according to their clinical condition. Results: The male to female ratio was 2.1:1 aged 23 - 69 years, mean being 40.24 ±12.59 years. The time of presentation after the ureteral stenting was 7 - 180 months (mean = 28.89 ±33.435 years). Seven patients (18.4%) reported with chronic kidney disease, including ESRD in two cases. Recurrent UTI was seen in 28 cases (73.6%), calculus formed over the stents in 20 cases (52.6%), and stent fragmented in 5 patients (13.1%). Majority of patients, (n = 23, 60.5%), were not even aware of the placement of these stents while 8 (21.0%) knew but were reluctant about its removal. In 3 cases (7.8%), the relatives knew about the stent but never informed the patients. The stent had been removed in 2 cases (5.2%), but the other broken fragment was missed. One case (2.6%) each had a misconception about the permanent placement of the stents like cardiac stents and regarding degradation of the stents in situ. Conclusion: Forgotten ureteral stents produce clinical features ranging from recurrent UTI to ESRD. This preventable urological complication is primarily due to the unawareness or ignorance of the patients and their relatives regarding the stent.

Publication Details

Page(s) 208-212

DOI DOI not available

Published Journal: Journal of College of Physicians and Surgeons--Pakistan : JCPSP, Volume: 26, Issue: 3, Year: 2016

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References

DamianoR,OlivaA,EspositoC,De SioM,AutorinoR,D'Armiento M., 2002.Early and late complications of double pigtail ureteral stent,Urol Int 69 136 -40

EisnerB,KimH,SaccoD., 2006.Repeat knot formation in a patient with an indwelling ureteral stent,Int Braz J Urol 32 308 -9

SinghV,SrinivastavaA,KapoorR,KumarA, 2005.Can the complicated forgotten indwelling ureteric stents be lethal?,Int Urol Nephrol 37 541 -6

MurtazaB,NiazNA,AkmalM,AhmadH,MahmoodA, 2011.A rare complication of forgotten ureteral stent,J Coll Physicians Surg Pak 21 190 -2

RoemerFD, 2000.There isn't an ideal smooth-surface material-yet: The history and future of urologic materials,J Endourol 14 1 -4

MahmoodA,ShahSS,AbbasiMH, 2006.Applications and complications of polyurethane stenting in urology,J Ayub Med Coll Abbottabad 18 69 -72

ChewBH,DenstedtJD, 2004.Technology insight: Novel ureteral stent materials and designs,Nat Clin Pract Urol 1 44 -48

ChoongS,WhitfieldH. Biofilms, 2000.and their role in infections in urology,BJU Int 86 935 -41

WattersonJD,CadieuxPA,BeikoDT, 2003.Oxalate-degrading enzymes from oxalobacter formigenes: A novel device coating to reduce urinary tract biomaterial-related encrustation,J Endourol 17 269 -74

El FaqihSR,ShamsuddinAB,ChakrabartiA,AtassiR,KardarAH,OsmanMK, 1991.Polyurethane internal ureteral stents in treatment of stone patients: morbidity related to indwelling times,J Urol 146 1487 -91

LojanapiwatB, 2005.Endourological management of severely encrusted ureteral stents,J Med Assoc Thai 88 1203 -6

ZismanA,SiegelYI,SiegmannA,LindnerA, 1995.Spontaneous ureteral stent fragmentation,J Urol 153 718 -21

PaickSH,ParkHK,OhSJ,KimHH, 2003.Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent,Urology 62 214 -17

LasaponaraF,DalmassoE,SantiàS,SedighO,BosioA,PasqualeG, 2013.An 8-year-forgotten ureteral stent after kidney transplantation: treatment and long-term follow-up,Urologia 80 80 -2

SomersWJ, 1996.Management of forgotten or retained indwelling ureteral stents,Urol 47 431 -5

AravantinosE,GravasS,KaratzasAD,TzortzisV,MelekosM, 2006.Forgotten, encrusted ureteral stents: a challenging problem with an endourologic solution,J Endourol 20 1045 -9

CurtisC,JasonB,MatthewP, 2009.Novel approach for removal heavily encrusted urinary stent,Can J Urol 16 4831 -5

SancaktutarAA,AdanurS,ResorluB,TepelerA,ZiypakT,SöylemezH, 2013.The forgotten ureteral stent in children: from diagnosis to treatment,J Urol 189 1054 -60

YehCC,ChenCH,LinCH,ChangCH,WuHC, 2004.A new technique for treating forgotten indwelling ureteral stents: silk loop assisted ureterorenoscopic lithotripsy,J Urol 171 719 -21

MistryK,PalP,ChitaleS., 2013.A simple two-stage “bailout” technique for the removal of an unyielding ureteric stent,Urol 82 242 -4

AronM,AnsariMS,SinghI,GautamG,KollaSB,SethA, 2006.Forgotten ureteral stents causing renal failure: multimodal endourologic treatment,J Endourol 20 423 -8

LynchMF,GhaniKR,FrostI,AnsonKM, 2007.Preventing the forgotten ureteral stent: implementation of a web-based stent registry with automatic recall application,Urol 70 423 -6

SancaktutarAA,TepelerA,SoylemezH,PenbegulN,AtarM,BozkurtY, 2012.A solution for medical and legal problems arising from forgotten ureteral stents: initial results from a reminder short message service (SMS),Urol Res 40 253 -8

ChewBH,PatersonRF,ClinkscalesKW,LevineBS,ShalabySW,LangeD., 2013.In vivo evaluation of the third generation biodegradable stent: a novel approach to avoiding the forgotten stent syndrome,J Urol 189 719 -25

AtherM,TalatiJ,BiyabaniR, 2000.Physician responsibility for removal of implants: the case for a computerized program for tracking overdue double-J stents,Techniques in Urol 6 189 -92