Open Access | Case Report
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Double J stent migration in the contralateral ureter during robotassisted pyeloplasty: an unique complication
*Corresponding author: Riccardo Bientnesi, MD.
Mailing address: Agostno Gemelli Hospital Foundaton - IRCCS,
Department of Urology, Catholic University of Sacred Heart,
Medical School, Rome, Italy.
Email: riccardo.bientnesi@gmail.com
Received: 23 July 2020 / Accepted: 24 August 2020
DOI: 10.31491/CSRC.2020.09.059
Abstract
The placement of double-J (DJ) stent in the urinary tract is a part of urologic practice for many indications. However, this may cause many complications ranging from stent-related irritative lower urinary tract symptoms (LUTS) to advanced renal failure. Although complications such as encrustations, proximal, and distal migrations within the pelvicaliceal system (PCS) are reported frequently in the literature, stent displacement into the contralateral ureter is rare and not previously described at our knowledge.
Keywords
Double J stent dislocation; robotic pyeloplasty; hydronephrosis
Introduction
The placement of double-J (DJ) stent in the urinary tract is an integral part of urologic practice for various indications. However, DJ stent placement may cause many complications ranging from stent-related irritative lower urinary tract symptoms (LUTS) to advanced renal failure in case of a forgotten stent [1]. Although complications such as encrustations, proximal, and distal migrations within the pelvicaliceal system (PCS) are reported frequently in the literature, stent displacement into the contralateral ureter is rare and not previously described at our knowledge. Herein, we present a case of a DJ stent migration into the distal portion of the contralateral ureter, causing hydronephrosis and lumbar pain.
Case Report
Materials and methods
A 25 years-old Caucasian man came to our attention
because of a right pielo-ureteral junction stricture with hydronephrosis. His past medical history was negative.
Physical examination was within normal limits. We
performed a robot-assisted right pieloureteroplasty;
during the procedure, a double-J stent was placed in an
anterograde way on a hi-wire guide, after the anastomoses posterior plate confection. The correct positioning of the stent into the bladder was verified through
bladder filling with dye.
During the first post-operative day, patient began
complaining of left flank pain and hematuria. An ultrasound scan was performed and left hydronephrosis
was found. Thus, we perform a radiograph (KUB) that
showed DJ stent with radiopaque coil in the right renal
and the distal coil lying into the supposed path of the
left ureter (Figures 1 and 2). The patient underwent
cystoscopy that confirmed the diagnosis (Figure 3).
The distal coil of the stent was exctracted from the left
ureter and replaced into the bladder, under radiological control. The postoperative recovery was uneventful
and the patient underwent DJ stent removal after 6
weeks with no complications.
Discussion
Since its inception by Zimskind the placement of DJ stent became an integral part of urologic armamentarium [2]. However, DJ stent placement is not free of complications. The most common complications are irritative LUTS, sovrapubic pain and vesico-ureteral reflux resulting in flank pain [3]. Although proximal and distal migration of ureteral stent is a relatively common occurrence, displacement of the stent into the contralateral ureter is an extremely rare case, never described in literature at our knowledge. In our case, we suggest that the guidewire, inserted into the right ureter at the UPJ, arrived in the bladder through the right ureteral orifice and took the road to the left ureteral orifice, going up to the left pelvic ureter. Consequently, also the DJ stent was placed with its distal coil into the left ureter. As the distal end of the stent was lying into the left ureter lumen, occluding the same, the patient had left flank pain and hydronephrosis. In our case, a cystoscopy with stent replacement guaranteed an optimal management. In the future, in order to prevent this very rare complication, although the intraoperative bladder filling with dye, an x-ray control should be performed at the end of the procedure.
Declarations
Authors’ contributions
Bientinesi R, Sacco E: Ideating, writing and supervision. Gandi C, Campetella M: Performed data acquisition, as well as provided administrative, technical, and material support.
Conflicts of interest
The author declares that there is no conflict of interest.
References
1. Sohrab, A., Aneesh, S., Sureka, S. K., Varun, M., Nitesh, P.,
Manoj, K., & Rakesh, K. (2015). Forgotten reminders: an
experience with managing 28 forgotten Double-J stents
and management of related complications. Indian Journal of Surgery, 77(3), 1165-1171.
2. Zimskind, P. D., Fetter, T. R., & Wilkerson, J. L. (1967).
Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. The Journal of urology, 97(5), 840-844.
3. Dyer, R. B., Chen, M. Y., Zagoria, R. J., Regan, J. D., Hood,
C. G., & Kavanagh, P. V. (2002). Complications of ureteral
stent placement. Radiographics, 22(5), 1005-1022.