Milicevic S et al, 2015: Encrustation of the Ureteral Double J Stent in Patients with a Solitary Functional Kidney - a Case Report.
Milicevic S, Bijelic R, Jakovljevic B.
Urology Clinic, University Hospital Clinical Center Banja Luka, Bosnia and Herzegovina.
Community Health Center, Banjaluka, Bosnia and Herzegovina.
ZU "S.tetik" Daily Oncology Hospital, Banja Luka, Bosnia and Herzegovina.
Abstract:
INTRODUCTION: The efficacy of ureteric stents in the management of various urological conditions causing the upper urinary tract obstruction has been extensively proven, and their contribution to urology remains enormous. The clinical use of ureteric stents is associated with several complications. "Stent syndrome," encrustation, migration and urothelial hyperplasia are the most common problems related to long-term ureteral stenting.
CASE REPORT: This work presents an interesting case from our practice: a complete encrustation of a classical polyurethane double J stent two and a half months after its initial instillation, in a 70 year old man, with a solitary functioning kidney, as well as successful removal of it by using a simultaneous treatment of extracorporeal lithotripsy and ureteroscopy with a contact disintegration of encrustations and with
percutaneous nephrostomy, as an auxiliary procedure for providing of additional urine derivation.
CONCLUSION: These problems can be overcome by the introduction of new advanced ureteral stent designs and biomaterials.
Med Arch. 2015 Aug;69(4):265-8. doi: 10.5455/medarh.2015.69.265-268. Epub 2015 Aug 4. FREE ARTICLE
Comments 1
This case represents a stent problem occasionally encountered clinically with very fast deposition of crystal/stone material on the surface of the material.
No data are available on the chemical composition of the encrustations, although it is likely that they were composed of infection stone material (magnesium ammonium phosphate, carbonate apatite and hydroxyapatite). Acinetobacter that was demonstrated in urine cultures is a potential producer of urease [1,2].
In all such cases, percutaneous chemolysis with Renacidin following crystal disintegration with SWL along the stent is the least invasive approach.
There was no explanation provided why the initial stone was so difficult to disintegrate (four sessions).
Reference
1. Henderson A. The urease activity of Acinetobacter lwoffi and A anitratus. J Gen Microbiol 1967;46:399-406
2. Dewan B, Sharma M, Nayak N, Sharma SK. Upper urinary tract stones & Ureaplasma urealyticum.
Indian J Med Res. 1997; 105:15-21.