Ali Rao Nouman, Anwaar Adeel, Ul Haq Inam, Irfan Sohaib, Irfan Wajiha, Karamat Riyan Imtiaz, Akilimali Aymar, Zafar Mahtab
Department of Urology, District Head Quarter Hospital Khanewal, Khanewal, Pakistan.
Department of Urology, Urology Suite, Midcity Hospital, Lahore, Pakistan.
Ann Med Surg (Lond). 2025 Apr 10;87(6):3874-3879. doi: 10.1097/MS9.0000000000003248. eCollection 2025 Jun.
Epitaxy is a process of stone formation in an intricate pattern of layers over a nidus. This case report highlights rare phenomenon of cystolith formation through epitaxy on a leftover curl of double j stent (DJ stent), emphasizing the importance of careful post-removal assessment and management to prevent complications.
A 30-year-old male presented with dysuria and intermittent urination for 1 month. He had a history of ureterolithotripsy and DJ stent insertion 3 years ago, with a difficult stent removal a year prior. Examination revealed suprapubic tenderness, and lab tests showed normal blood count and renal function, with some red and white blood cells in urine. Imaging revealed a >5 cm bladder stone associated with a leftover DJ stent curl. After stabilizing the patient, cystolithotomy was performed, removing large stone, and stent curl. The stent curl likely served as the core for stone formation. The patient recovered well during follow-up visits.
Ureteral stents, developed over a century ago, are widely used in urology, particularly after upper tract stone procedures. However, prolonged use of DJ stent can lead to complications, including encrustation, breakage, and stone formation, especially calcium phosphate stones. There are many conditions that lead to stone formation on DJ stents like urinary tract infections, metabolic disorders, recurrent stone disease, and prolonged indwelling time of stent inside the urinary system.
Careful monitoring and management of foreign bodies in the bladder are crucial to prevent vesical stone formation. Timely removal of DJ stents is essential to avoid encrustations and ensure complete elimination, preventing future nidus-related stones. Proper handling of impacted DJ stents is vital during treatment.
上皮细胞化生是结石在核心物上以复杂分层模式形成的过程。本病例报告强调了双J支架（DJ支架）残留卷曲物上通过上皮细胞化生形成膀胱结石这一罕见现象，强调了移除后仔细评估和管理以预防并发症的重要性。
一名30岁男性出现尿痛和间歇性排尿1个月。他3年前有输尿管碎石术和DJ支架置入史，1年前支架移除困难。检查发现耻骨上压痛，实验室检查显示血常规和肾功能正常，尿液中有一些红细胞和白细胞。影像学检查发现一个大于5厘米的膀胱结石与DJ支架残留卷曲物有关。在使患者病情稳定后，进行了膀胱结石切除术，取出了大结石和支架卷曲物。支架卷曲物可能是结石形成的核心。患者在随访期间恢复良好。
输尿管支架在一个多世纪前就已研发出来，在泌尿外科广泛应用，尤其是在上尿路结石手术后。然而，DJ支架的长期使用会导致并发症，包括结痂、断裂和结石形成，尤其是磷酸钙结石。有许多情况会导致DJ支架上形成结石，如尿路感染、代谢紊乱、复发性结石病以及支架在泌尿系统内的长期留置时间。
对膀胱内异物进行仔细监测和管理对于预防膀胱结石形成至关重要。及时移除DJ支架对于避免结痂和确保完全清除至关重要，可防止未来与核心物相关的结石形成。在治疗过程中正确处理嵌顿的DJ支架至关重要。
