Evolution of a neglected ureteral stent

Excerpt

A 27-year-old woman with a history of recurrent nephrolithiasis presented with right flank and suprapubic pain for 4-day duration. She also complained of fever and chills. She had a right ureteral double J stent placed 3 years prior to presentation for right-sided urolithiasis. The stent was not exchanged or removed during this period as she was lost to follow-up with the urologist. She had a fever of 38.2 °C, and other vital signs were normal. Physical examination was unremarkable except for tenderness in the right costo-vertebral angle. Urinalysis revealed about 1600 white blood cells and 400 red blood cells per high power field. She was admitted to the hospital, and started on intravenous antibiotics for pyelonephritis. Later, urine culture grew more than 100,000 col/ml Klebsiella pneumoniae. An abdominal computed tomography (CT) scan was obtained on day 3 of admission because of persistent abdominal pain and fever, to rule out possible perinephric abscess. It showed right pelvi-ureteral junction nephrolithiasis with an encrusted right ureteral stent, and a large bladder stone (Figs. 1, 2). Cystoscopy showed a large, free floating ~6 cm spherical stone within the bladder. She subsequently underwent cystolithalopaxy, laser lithotripsy, right percutaneous nephrolithotomy and removal of the distal retained stent. Most of the stone burden including the bladder and uretero-pelvic junction stones was removed. Stone analysis revealed carbonate apatite and magnesium ammonium phosphate hexahydrate.

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