Urinary bladder stone due to retained indwelling ureteral stent: A case report

Abstract

Rationale: 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.

Patient concerns: 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.

Diagnosis: 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.

Interventions: Pneumatic ballistic lithotripsy was used for crushing the bladder calculi followed by the successful extraction of intact D-J ureteral stent.

Outcomes: 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.

Lessons: This case reminds us that it is crucial to take various measures to avoid the forgotten ureteral stent and its unfortunate late complication.

Figure 1

Preoperative KUB x-ray showed an entire coiled D-J stent with a giant stone in the bladder. D-J stent = double-J stent, KUB = kidney ureter bladder.

Figure 2

Giant bladder stone, an encrusted D-J stent, normal left kidney, and right hydronephrosis on CT scans. CT = computed tomography, D-J stent = double-J stent.

Figure 3

Intact D-J ureteral stent with uncomplicated stent encrustation following removal. D-J stent = double-J stent.

Figure 4

No residual kidney and bladder stone was detected on postoperative KUB x-ray and CT scans. CT = computed tomography, KUB = kidney ureter bladder.