Zhang Fuxun, Yu Jianhong, Wang Qianlong, Lu Yiping
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan.
Department of Urology, the Affiliated Hospital of Gansu Medical College, Pingliang, Gansu, China.
Medicine (Baltimore). 2020 Sep 25;99(39):e22293. doi: 10.1097/MD.0000000000022293.
The indwelling ureteral stents is a common procedure in routine urological practice. The double-J (D-J) stent is the most common type of stents used and is indicated mainly for short-term urinary drainage and prevention of obstruction and infection. However, prolonged indwelling stents may result in disastrous complications, such as hematuria, infection, encrustation, and stone formation. In this context, the persistence of stent in situ might play a key role as a nidus in deposition of urinary sediment, then forming calculus. Although the encrustation may become more serious as time goes on, large bladder stones are relatively rare. However, the serious encrustation and giant stone may complicate or exacerbate the conditions in turn.
A 45-year-old female patient who underwent right ureteral stent placement after open ureterolithotomy 6 years ago complained of dysuria, urinary frequency, and urgency over 2 months.
The kidney ureter bladder (KUB) x-ray showed the presence of a giant stone in the bladder and an entire D-J stent. The computed tomography (CT) urography scans revealed normal left kidney, right hydronephrosis, and an encrusted D-J stent with the significant stone, diameter 4.2 cm with a CT value of 1211.0 ± 221.6 HU, on the vesical coil. On the basis of these auxiliary examinations, the case was diagnosed as cystolith and prolonged-indwelling stents.
Pneumatic ballistic lithotripsy was used for crushing the bladder calculi followed by the successful extraction of intact D-J ureteral stent.
No residual stone was detected on postoperative KUB x-ray and CT urography scans. Patient recovered well and was discharged 10 days after surgery. Semi-annual ultrasound examination was suggested to monitor the effect of therapy.
This case reminds us that it is crucial to take various measures to avoid the forgotten ureteral stent and its unfortunate late complication.
留置输尿管支架是泌尿外科常规操作中的常见手术。双J（D-J）支架是最常用的支架类型，主要用于短期尿液引流以及预防梗阻和感染。然而，长期留置支架可能会导致灾难性并发症，如血尿、感染、结石形成和结石。在这种情况下，支架原位存留可能作为尿沉渣沉积的核心起关键作用，进而形成结石。尽管随着时间推移结石可能会变得更严重，但巨大膀胱结石相对少见。然而，严重的结石和巨大结石可能反过来使病情复杂化或加重。
一名45岁女性患者，6年前开放性输尿管取石术后行右侧输尿管支架置入，2个月来出现排尿困难、尿频和尿急。
腹部平片显示膀胱内有巨大结石及完整的D-J支架一枚。计算机断层扫描（CT）尿路造影显示左肾正常，右肾积水，膀胱段D-J支架结石形成，结石直径4.2 cm，CT值1211.0±221.6 HU（亨氏单位）。基于这些辅助检查，该病例诊断为膀胱结石伴支架长期留置。
采用气压弹道碎石术粉碎膀胱结石，随后成功取出完整D-J输尿管支架。
术后腹部平片和CT尿路造影未发现残余结石。患者恢复良好，术后10天出院。建议每半年进行超声检查以监测治疗效果。
该病例提醒我们采取各种措施避免遗忘输尿管支架及其不幸的晚期并发症至关重要。
