Presented by: Deepak Janardhanan MCh, FACS, FEBU
Fakeeh University Hospital

Introduction

Polyurethane, due to its low cost, high versatility and availability, it commonly used for ureteral stents. Spontaneous fracture of these stents is rare.

Since 1967, the indwelling ureteral stent has become a fundamental part of urology practice in an era of expanding endourological procedures. Ureteral stents are used in a variety of indications for renal transplantation, genitourinary oncology, trauma and reconstructive surgeries. Polyurethane, due to its low cost, high versatility and availability, is commonly used for ureteral stents. Since its introduction, complications had been encountered and resulted in significant morbidity. Pain, bladder irritative symptoms and fever are signs of early complications related to polyurethane ureteral stents; moreover, late complications, such as encrustation, infections and fragmentation, are more troublesome. Cases of fragmented ureteral stents are rare and are classified as grade 3 on the Clavien Classification of Surgical Complications

Materials

35-year-old male with no known medical comorbidities consulted at the outpatient clinic due to right flank pain and gross hematuria. Eight months earlier, he had 6 × 24-cm Tecoflex polyurethane double pigtail ureteral stent inserted on the right side for temporary relief of post-intracorporeal lithotripsy ureteral edema at another facility.

Physical examination was unremarkable. Routine biochemical parameters were normal: urinalysis revealed proteinuria (250 mg/dL) hematuria red blood cells (RBC) (3+ blood) .Urine culture showed no growth.

 A X ray KUB and computed tomography (CT) showed an fractured indwelling right ureteral stent with missing distal part of the stent below L5 vertibral body.  dilated pelvicalyceal system of the right kidney was also noted. Retrieval of stent fragment was done video-assisted using Fr 6.5 semi-rigid ureteroscope with the patient placed on lithotomy Fowler’s position. On ureteroscopy, the ureteral mucosa on the right proximal segment of the ureter appeared edematous and erythematous. Using a ureteral foreign body grasper, we removed the stent fragments as piece meal under direct visualization on the camera monitor. Open ureteral catheter was removed after 48 hours. The patient recovered well and discharged on postoperative day 3.

 

Results

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When the stent is exposed to different factors in the urine and the urothelium for a long time, it may lead to loss of strength, elasticity and flexibility of the stent; the degradation of stent polymers leads to loss of tensile strength and hardening of the stent. When the stent is exposed to different factors in the urine and the urothelium for a long time, it may lead to loss of strength, elasticity and flexibility of the stent; the degradation of stent polymers leads to loss of tensile strength and hardening of the stent. When the stent is exposed to different factors in the urine and the urothelium for a long time, it may lead to loss of strength, elasticity and flexibility of the stent; the degradation of stent polymers leads to loss of tensile strength and hardening of the stent.

Conclusion

Retrieving a proximally fragmented double-J ureteral stent can be frustrating and technically challenging. Strategy to prevent stent fracture is to decrease the time of the indwelling stent and strict follow-up using a computerized patient registry to track patients.

Funding

nil