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Nerli RB et al, 2016: Forgotten/retained double J ureteric stents: A source of severe morbidity in children.

Nerli RB, Magdum PV, Sharma V, Guntaka AK, Hiremath MB, Ghagane S.
Department of Urology, KLES Kidney Foundation, KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India.
PG Department of Studies in Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India.

Abstract

BACKGROUND: The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents.
MATERIALS AND METHODS: Hospital records of all patients' <18 years old who underwent removal of forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed.
RESULTS: During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it.
CONCLUSIONS: Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain. 

Afr J Paediatr Surg. 2016 Jan-Mar;13(1):32-5. doi: 10.4103/0189-6725.181704.

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Comments 1

Hans-Göran Tiselius on Monday, 19 September 2016 10:43

Encrustation of stents left in the ureter during (too) long periods of time might cause considerable problems at removal. It is emphasized in this report that a registry is necessary to keep track of all patients in whom stents are inserted and to make sure that the number of inserted stents is the same as the number of removed stents. Ideally such a registry should be computerized with automatic warnings when the recommended treatment period has been passed.

Some points need to be considered in order to avoid problems of this kind:

Do not overuse stents for SWL in children. Their ureters have a great capacity for passage of fragments.

Whichever method that is used for removal of a stent with encrustations, always start with SWL to dislodge as much crystalline material as possible.

It is my own experience that in a large number of patients the crystallization on stents is caused by infection (urease producing micro-organisms). In selected patients with magnesium ammonium phosphate/carbonate apatite encrustations, dissolution with Renacidin® (hemicaidrin) via a percutaneous nephrostomy catheter is a gentle procedure that eliminates the crystalline material with minimal or no trauma to the tissues.

Encrustation of stents left in the ureter during (too) long periods of time might cause considerable problems at removal. It is emphasized in this report that a registry is necessary to keep track of all patients in whom stents are inserted and to make sure that the number of inserted stents is the same as the number of removed stents. Ideally such a registry should be computerized with automatic warnings when the recommended treatment period has been passed. Some points need to be considered in order to avoid problems of this kind: Do not overuse stents for SWL in children. Their ureters have a great capacity for passage of fragments. Whichever method that is used for removal of a stent with encrustations, always start with SWL to dislodge as much crystalline material as possible. It is my own experience that in a large number of patients the crystallization on stents is caused by infection (urease producing micro-organisms). In selected patients with magnesium ammonium phosphate/carbonate apatite encrustations, dissolution with Renacidin® (hemicaidrin) via a percutaneous nephrostomy catheter is a gentle procedure that eliminates the crystalline material with minimal or no trauma to the tissues.
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