Forgotten ureteral stents causing renal failure: multimodal endourologic treatment.
OBJECTIVE
To report our experience in managing nine patients with forgotten ureteral stents that resulted in chronic renal failure (CRF).


METHODS
We reviewed our stent records from January 1994 to January 2004 to analyze cases of forgotten indwelling ureteral stents in solitary kidneys that had led to CRF (serum creatinine 4-14 mg/dL). These patients had normal renal function prior to the interventions at which stents were placed. They were subjected to multimodal endourologic management, including cystolithotripsy and ureteroscopic and percutaneous lithotripsy, to make them stent and stone free in a single operative session.


RESULTS
The median dwell time of the retained stents was 39 months. Three patients were not aware of the stent, while six chose to ignore it. All patients underwent a temporizing percutaneous nephrostomy with an 8F pigtail catheter and were operated on 2 to 4 weeks later. All nine patients were rendered stone and stent free; however, one patient succumbed to septic complications 3 weeks after the operation. At last follow-up (6-56 months), two patients are on the transplant waiting list, while six are living with mild to moderate renal failure on conservative treatment.


CONCLUSIONS
Chronic renal failure caused by encrusted stents in a functionally solitary kidney is a disastrous complication of forgotten stents. Prevention is, of course, ideal, but such cases are still seen despite increasing awareness. Temporizing percutaneous nephrostomy, renal support, and skilled endourologists are the cornerstones of management of such high-risk cases.
Aron
Monish
M
Department of Urology, All India Institute of Medical Sciences, New Delhi, India. monisharon@hotmail.com
Ansari
Mohammed S
MS
Singh
Iqbal
I
Gautam
Gagan
G
Kolla
Surendra B
SB
Seth
Amlesh
A
Gupta
Narmada P
NP
D000328:Adult; D003401:Creatine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000209:etiology*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014511:Uremia / Q000000981:diagnostic imaging / Q000209:etiology; D014513:Ureter / Q000000981:diagnostic imaging; D014545:Urinary Calculi / Q000628:therapy*
D003401:Creatine