Sakr Mohamed, Badran Merhan, Pokhrel Prakriti, Asfeen Ummul Z, Badran Nadin Nouh, Badran Maram Wahed
Alexandria Faculty of Medicine, Alexandria, Egypt.
Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.
Ann Med Surg (Lond). 2023 Nov 7;85(12):6289-6293. doi: 10.1097/MS9.0000000000001478. eCollection 2023 Dec.
A ureteral stent is crucial for managing urinary flow obstruction, ureteral reconstructive surgeries, and iatrogenic ureteral injuries. The authors aim to report a case of forgotten double-J stent for 17 years, the longest time reported in literature in a patient with solitary kidney and no typical long-term complications as stones formation and encrustation.
A 58-year-old male with chronic kidney disease and solitary left kidney presented with left loin pain. With creatinine higher than baseline (6.2 mg/dl), he reported a neglected double-J stent placed 17 years ago in a different hospital. In addition, non-contrast computed tomography and cystoscopy revealed hydronephrosis, cystitis, and an element of infra-vesical obstruction, evident by high bladder neck. Treatment included left percutaneous nephrostomy, but he was readmitted few weeks later for cystoscopy, ureteroscopy, and a new double-J insertion. Due to worsening renal function, he was readmitted four weeks later for cystoscopic removal of the new double-J stent and Transurethral Resection of the Prostate, after which creatinine returned to baseline.
Double-J stents are vital in urological procedures, but neglecting their presence can lead to severe complications like encrustations, stone formation, stent fractures, hydronephrosis, infections, and renal function loss. Treatment of long-term complications is difficult and should consider many factors, including the type and severity of associated complications and the patient's preoperative status.
Preventing complications from neglected or forgotten double-J stents through patient education and follow-up is crucial, especially in those with solitary functioning kidneys due to the imminent loss of renal function.
输尿管支架对于处理尿路梗阻、输尿管重建手术及医源性输尿管损伤至关重要。作者旨在报告一例遗忘双J支架达17年的病例，这是文献报道中在单肾患者中遗忘时间最长的病例，且未出现结石形成和结壳等典型长期并发症。
一名58岁患有慢性肾病且左肾为单肾的男性，因左腰部疼痛就诊。其肌酐水平高于基线（6.2mg/dl），他自述17年前在另一家医院放置了双J支架后被遗忘。此外，非增强计算机断层扫描和膀胱镜检查显示肾积水、膀胱炎以及膀胱颈抬高所致的膀胱下梗阻。治疗措施包括左侧经皮肾造瘘术，但几周后他因膀胱镜检查、输尿管镜检查及重新插入新的双J支架再次入院。由于肾功能恶化，四周后他再次入院进行膀胱镜下取出新的双J支架及经尿道前列腺切除术，术后肌酐水平恢复至基线。
双J支架在泌尿外科手术中至关重要，但忽视其存在可能导致严重并发症，如结壳、结石形成、支架断裂、肾积水、感染及肾功能丧失。长期并发症的治疗困难，应考虑诸多因素，包括相关并发症的类型和严重程度以及患者术前状况。
通过患者教育和随访预防因忽视或遗忘双J支架导致的并发症至关重要，尤其是对于单功能肾患者，因为肾功能可能会迅速丧失。
