scholarly journals Proximal migration of a ‘double J’ ureteric stent in a patient with a staghorn calculus

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Emily J Burns ◽  
Peter M Smith ◽  
Matthew Liew
Keyword(s):  
Renal Pelvis ◽  
Obstructive Uropathy ◽  
Stent Migration ◽  
Interesting Case ◽  
Ureteric Stent ◽  
Mechanical Disruption ◽  
Ureteric Stents ◽  
Proximal Migration ◽  
Stent Length ◽  
Staghorn Calculus

Abstract Ureteric stents are widely used for the management of obstructive uropathy and intraoperative identification of the ureters. Despite undergoing numerous modifications since their introduction in 1967, they are frequently associated with complications ranging from irritative symptoms to migration of the stent. Proximal migration of ureteric stents is a relatively uncommon occurrence, with a reported incidence of 1–4.2%; it is usually associated with inappropriate stent length, poor positioning or incorrect deployment of the stent. Here we discuss an interesting case of a patient who unfortunately suffered proximal ureteric stent migration associated with pelvico-ureteric junction obstruction, despite appropriate stent choice, adequate deployment and confirmation of correct positioning. This complication likely occurred secondary to mechanical disruption of the stent caused by the presence of a large staghorn calculus within the renal pelvis.

Ureteric stents: The past, present and future

2017 ◽  
Vol 11 (4) ◽  
pp. 280-284 ◽  
Author(s):  
Kevin G Williams ◽  
Anthony JR Blacker ◽  
Priyadarshi Kumar
Keyword(s):  
Stent Migration ◽  
The Body ◽  
Metal Stents ◽  
Water Repellent ◽  
Ureteric Stent ◽  
The Past ◽  
Ureteric Stents ◽  
Distal Migration ◽  
The 1960S

Ureteric stents are fundamental to modern-day urological practice. This article aims to chronicle their development over the last century and the key individuals whose efforts have made their development possible. Early stents were ureteric catheters that were exteriorised outside the body and were associated with complications including migration, infection and encrustation. The use of polyethylene stents in humans was first reported by Tulloch in 1952. Polyethylene was thought to be a promising material due to its durability and water-repellent nature. It would, however, suffer the problems that would become associated with stents over the following decades mentioned above. The first silicone ureteric stents were developed in the 1960s by Zimskind and provided prolonged, efficient drainage but were complicated with stent migration. Collars, wings, flanges and barbs were developed to help prevent migration. Finney developed a double ‘pig-tail’ stent in the 1970s which helped to prevent both proximal and distal migration and the modern-day ureteric stent was born. Modern polymers have been developed such as polyurethane or styrene ethylene-butylene (C-flex®). Metal stents have also been used over the last three decades including the Wallstent™, Resonance® and Memokath™ stents. They have shown promising results particularly when long-term relief of ureteric obstruction is needed. Various strategies are available for removal including cystoscopically, stents with a metallic end that can be removed by using a catheter with a magnet at the proximal end, tethered stents that can be removed noninvasively either by the urologist, nurse or even by the patient and dissolvable stents which are in development.

Obstructive uropathy in the context of ureteroinguinal hernia: experience of challenges in surgical management of an unwell patient

2020 ◽  
Vol 13 (8) ◽  
pp. e235060
Author(s):  
Mitchell Egerton Barns ◽  
Arvind Vasudevan ◽  
Emma Lucy Marsdin
Keyword(s):  
Obstructive Uropathy ◽  
Anatomical Variation ◽  
Surgical Patients ◽  
Definitive Treatment ◽  
Ureteric Stent ◽  
Common Presentation ◽  
Iatrogenic Damage ◽  
Vesicoureteric Junction ◽  
Collecting System

This case exemplifies an unusual anatomical variation of a common presentation and highlights the importance of perioperative diagnosis and planning in complex surgical patients. A 72-year-old comorbid man presented to the emergency department with an infected obstructed right kidney secondary to an obstructing 12 mm vesicoureteric junction calculi. However, imaging also showed concurrent ureteroinguinal hernia associated with a 130 cm-long ureter, too long for conventional treatment with a ureteric stent. Acutely, the patient’s collecting system was decompressed via nephrostomy, but due to the rarity of this anatomical variation, definitive treatment had to be rethought to help reduce the risk of iatrogenic damage and the associated long-term complications.

scholarly journals Use of double-J ureteric stents post-laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in hydronephrosis for pediatric patients: a single-center experience

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091878
Author(s):  
Haobo Zhu ◽  
Jun Wang ◽  
Yongji Deng ◽  
Liqu Huang ◽  
Xiaojiang Zhu ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Ureteropelvic Junction Obstruction ◽  
Stent Migration ◽  
Ureteropelvic Junction ◽  
Laparoscopic Pyeloplasty ◽  
Clinical Variables ◽  
Single Center Experience ◽  
Post Surgery ◽  
Ureteric Stents ◽  
Double J Stent

Objectives We aimed to investigate the safety concerns associated with placing double-J ureteric stents post-laparoscopic pyeloplasty surgery for congenital ureteropelvic junction obstruction (UPJO) and hydronephrosis. Methods A total of 1349 patients with postoperative double-J stent placement at our center were included. Clinical variables for enrolled patients were collected by two independent authors. We compared clinical variables and the efficacy of stenting post-laparoscopic pyeloplasty. Results The mean age of the patients was 4.23 ± 2.39 years. A total of 58.49% of patients were diagnosed with left UPJO with hydronephrosis and 33.95% were diagnosed with right UPJO. Furthermore, 7.56% of patients had bilateral UPJO. In all cases, 96.96% of indwelling double-J stents were successfully removed 4 weeks post-surgery. A total of 3.04% of the patients still required further management, including stent migration to the renal pelvis (0.37%), stent migration to the bladder (0.30%), prolapse of the stent through the ureter (0.15%), blockage of stents (1.85%), and fouling of stents (0.37%). Conclusions Double-J ureteric stents used after laparoscopic pyeloplasty for treating UPJO in hydronephrosis for pediatric patients is a safe, feasible, and beneficial method, which can be recommended for routine procedures. However, caution should be practiced for follow-up and removal using this method.

scholarly journals Bilateral Migration of Open-Cell Design Carotid Stents in the Early Post-Procedure Period: A Rare Complication

2014 ◽  
Vol 20 (6) ◽  
pp. 761-765
Author(s):  
Amar Swarnkar ◽  
Shri Harsha Krishna ◽  
Nicole Zimmerman ◽  
Julius Latorre ◽  
Eric M Deshaies
Keyword(s):  
Rare Complication ◽  
Duplex Ultrasound ◽  
Stent Migration ◽  
Cell Design ◽  
Open Cell ◽  
Post Procedure ◽  
Proximal Migration ◽  
Bilateral Carotid ◽  
The Right ◽  
Bilateral Carotid Artery

We describe migration of bilateral carotid stents in a 63-year-old man shortly after stenting. Carotid stent migration was found four days post-procedure on the right side and one day post-procedure on the left side on angiography and duplex ultrasound, respectively. This is the first reported case of bilateral carotid artery stenting complicated by bilateral proximal migration of open-cell design stents in the early post-procedure period.

scholarly journals The Innovative Use of Ureter Catheter in the Surgery of Obstructive Uropathy

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xiangcheng Zhan ◽  
Ding Liu ◽  
Guangchun Wang ◽  
Haimin Zhang ◽  
Aimaitiaji Kadier ◽  
...  
Keyword(s):  
Real Time ◽  
Renal Pelvis ◽  
Obstructive Uropathy ◽  
Occult Blood ◽  
Effective Rate ◽  
Surgical Instruments ◽  
Circulation System ◽  
Control Group ◽  
Ureteral Stricture ◽  
Ureteral Catheter

Purpose. Relieving obstruction and protecting renal function are the main therapeutic purposes of obstructive uropathy which often involve surgical treatment, and the ureter catheter is one of the surgical instruments commonly used in surgery. We aimed to explore the innovative use of a ureter catheter in the surgery of obstructive uropathy. Methods. We used a ureteral catheter to innovate the surgical procedure of the most common causes of obstructive uropathy: ureteral calculi and stricture, establishing an internal circulation system (ICS), proposing a three-step dilatation method, and reviewing their effects on patients. Furthermore, we introduced a simple real-time intrapelvic pressure measurement device to monitor intrarenal pressure during operation. Results. Postoperative laboratory examination showed that blood CRP, leukocyte neutrophil level, changes in the hemoglobin, urine occult blood, and positive rate of urine culture in the ICS group are significantly lower than those in the control group, corresponding to a lower incidence of bleeding and infection-related complications clinically. A three-month follow-up revealed 1/3 rate of ureteral stricture in the ICS group comparing to the control. We applied the three-step dilatation in patients with severe stenosis in which the balloon could not pass; the overall effective rate was 90.9%. The pressure of the renal pelvis was displayed on the monitor in real time. The surgeon could estimate the degree of filling of the renal pelvis and adjust the intake volume through the data. Conclusion. The innovative application of ureteral catheters in the operation of obstructive uropathy can realize the real-time monitor of intraoperative renal pelvis pressure, reduce the incidence of lithotripsy postoperative complications, and expand the indications of balloon dilatation in ureteral stricture, which has certain clinical significance.

scholarly journals An Interesting Case of a 57-Year-Old Male with an Upper Gastrointestinal Bleeding and Obstructive Uropathy with Bilateral Hydronephrosis Diagnosed with Systemic Mucormycosis

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Dora E. Izaguirre-Anariba ◽  
Felicia Chee ◽  
Zeyar Thet ◽  
Jesus Lanza
Keyword(s):  
Gastrointestinal Bleeding ◽  
Amphotericin B ◽  
Upper Gastrointestinal Bleeding ◽  
Obstructive Uropathy ◽  
Stage Iv ◽  
Invasive Fungal Disease ◽  
Interesting Case ◽  
Pathology Report ◽  
Repeat Endoscopy ◽  
Upper Gastrointestinal

Mucormycosis is a rare and invasive fungal disease with high mortality rate caused by members of the order Mucorales. Mucorales species are vasotrophic organisms that may cause angioinvasive disease in immunosuppressed hosts. Risk factors include diabetic ketoacidosis, chronic kidney disease, organ or bone marrow transplantation, neutropenia, burns, malignancies, and steroid therapy. There are six different clinical presentations of mucormycosis, which includes rhino-orbital cerebral, pulmonary, gastrointestinal, cutaneous, disseminated, and miscellaneous infection. Here, we report a case of a 57-year-old male with stage-IV sarcoidosis on long-term steroids presenting with upper gastrointestinal bleeding and obstructive uropathy who was diagnosed with systemic mucormycosis. Biopsy obtained by endoscopy revealed necrotic debris with acute leukocytic exudate and numerous variably sized, 90-degree angulated fungal hyphae favoring mucormycosis-causing species. Imaging studies showed hydronephrosis, and cystoscopy findings were consistent with fungal infection of the bladder. Isavuconazonium sulfate was used as systemic salvage therapy along with continuous bladder irrigation with amphotericin-B for localized bladder infection after a trial with first-line systemic treatment with intravenous liposomal amphotericin-B failed. A repeat endoscopy showed inflammatory changes with a pathology report in which mucormycosis was no longer appreciated. The patient was discharged home to complete 6 months of antifungal therapy with monthly follow-ups. The patient has been asymptomatic after 12-month completion of therapy.

Feline double pigtail ureteric stents for management of ureteric obstruction: short- and long-term follow-up of 26 cats

2014 ◽  
Vol 16 (12) ◽  
pp. 985-991 ◽  
Author(s):  
Nicola Jayne Kulendra ◽  
Harriet Syme ◽  
Livia Benigni ◽  
Zoe Halfacree
Keyword(s):  
Stent Placement ◽  
Lower Urinary Tract ◽  
Ureteric Obstruction ◽  
Ureteric Stent ◽  
Ureteric Stents ◽  
Long Term Follow Up ◽  
Lower Urinary

The objective of this study was to determine the outcome of cats with ureteric obstruction managed with double pigtail ureteric stents and to document the incidence of lower urinary tract signs at long-term follow-up. Data were obtained retrospectively from the medical records (2009–2012) of 26 cats that underwent ureteric stent placement. Owners were contacted for follow-up, and a quality of life questionnaire completed. Survival to discharge after stent placement was 85% (22/26). Prevalence of postoperative uroabdomen necessitating further surgery was 15% (4/26). Stents were replaced 4–28 months after the initial surgery in four cats because of migration, fracture, encrustation causing luminal obstruction or sterile cystitis, respectively. Nine cats were alive at follow-up, which was 3–28 months after the original surgery. Nine cats had azotaemic chronic kidney disease and nine had signs related to sterile cystitis; three of these cats were euthanased as a result of the severity of the signs. Preoperative serum creatinine of the survivors (9.4 mg/dl, n = 9) was not significantly different from that of the non-survivors (6.5 mg/dl, n = 13; P = 0.295). Quality of life was assigned a mean score of 8/10. Median survival of cats following discharge was 419 days (range 44–994 days). Signs consistent with sterile cystitis affected 35% of cats. It was concluded that ureteric stent placement in cats was associated with a 15% mortality rate before hospital discharge. Long-term management of ureteric stents is associated with a high rate of lower urinary tract signs.

scholarly journals A survey of Canadian renal transplant surgeons: Use of ureteric stents and technique of the ureteroneocystotomy

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Luke F. Reynolds ◽  
Tad Kroczak ◽  
R. John Honey ◽  
Kenneth T. Pace ◽  
Jason Y. Lee ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Dwell Time ◽  
Online Survey ◽  
Primary Outcome ◽  
Prophylactic Antibiotics ◽  
Ureteric Stent ◽  
Stent Removal ◽  
Ureteric Stenting ◽  
Ureteric Stents

Introduction: The role of ureteric stenting in renal transplant has been well-demonstrated. The goal of this survey was to determine the use of ureteric stents by Canadian transplant surgeons and how the ureteroneocystotomy and followup is performed. Methods: An online survey was sent to the 40 surgeon members of the Canadian Society of Transplantation. The primary outcome was the rate of ureteric stent use at the time of renal transplantation. The secondary outcomes were the ureteric stent dwell time, use and type of prophylactic antibiotics, and the use of routine post-transplant ultrasonography. Results: All respondents (25) used ureteric stent routinely and 92% remove the stent between four and six weeks postoperatively. Prophylactic antibiotics were used 64% of the time for ureteric stent removal. The majority of surgeons do not routinely perform a post-stent removal ultrasound. Fifty-six percent of respondents perform a refluxing anastomosis. Conclusions: Ureteric stents are routinely used in renal transplant in Canada. Areas for improvement and topics of debate identified from this survey are the need for peri-stent removal antibiotics, the role of post-stent removal ultrasound, the duration of stent dwell time, and the need for a non-refluxing ureteroneocystotomy.

scholarly journals Advanced Renal Pelvic Carcinoma Revealed after Treatment of a Staghorn Calculus by Endoscopic Combined Intrarenal Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ichiro Tsuboi ◽  
Yuki Maruyama ◽  
Motoo Araki ◽  
Nobuyoshi Ando ◽  
Yasuhiro Nishiyama ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Renal Pelvis ◽  
Rare Condition ◽  
Flank Pain ◽  
Contrast Enhanced ◽  
Staghorn Calculus ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Renal pelvis carcinoma associated with staghorn calculus is a clinically rare condition. A 66-year-old man presented with flank pain due to an 8 cm complete staghorn calculus. We performed three lithotomies using endoscopic combined intrarenal surgery and carried out intraoperative biopsy. Histopathological examinations revealed a keratinized lesion. One month later, contrast-enhanced computed tomography showed an advanced renal pelvis carcinoma. These findings demonstrate that even an intraoperative biopsy may be insufficient to diagnose a renal pelvis carcinoma associated with a staghorn calculus. The possibility of RPCa developing when treating a long-standing staghorn calculus should therefore be kept in mind.

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