Long-Term Passive Ureteral Dilatation with Double-J Stent: Possibly an Effective Treatment for Recurrent Renal Colic Caused by Papillary Renal Necrosis

Abstract

Background: An uncommon cause of recurrent renal colic is mucous tissue passage secondary to renal papillae necrosis. Because of its low prevalence, the correct management of recurrent obstructive uropathy produced by renal papillary necrosis (RPN) is not well defined. Case Presentation: We present a case of recurrent renal colic associated with the expulsion of mucous tissue in a young woman's urine with a history of excessive consumption of nonsteroidal anti-inflammatory drugs (NSAIDs). The patient required multiple admissions to the emergency department because of recurrent episodes of renal colic. A retrograde pyelogram and histopathologic study of the expulsed tissue supported the diagnosis of RPN. The patient was managed with Double-J stents for 12 months, complete withdrawal of NSAIDs, and large volume intake of water. A satisfactory outcome was seen radiologically and endoscopically after treatment. The patient stopped experiencing new renal colic episodes because of the passive ureteral dilatation despite still presenting the mucous tissue expulsion in the urine. Conclusions: Passive ureteral dilatation with Double-J stents could possibly be an effective treatment for patients with recurrent renal colic secondary to persistent renal papillae necrosis.

Keywords: infection/inflammation; obstruction; stents; ureteroscopy; ureteroscopy instrumentation.

FIG. 1.

(a) Mucous—membranous tissue expulsed in the urine. (b) Retrograde pyelography with arrows pointing irregularities and bulging of the superior calices with clefts that extend from the fornices to the pyramid tip (lobster claw sign).

FIG. 2.

Hematoxylin and eosin staining (100 × ) of the mucous expulsed material. Mixed inflammatory elements such as lymphocytes and macrophages, polymorphonuclear cells (white arrow) associated with bacterial groups (arrowhead) can be found. Also, some groups of fibroblasts embedded in a hemorrhagic background can be found that are compatible with an exacerbated chronic inflammatory process.

FIG. 3.

Endoscopic images of the last flexible ureteroscopy showing normal renal papillae. (a) Upper pole papillae and (b) interpolar papilla.

FIG. 4.

Retrograde pyelography at 12 months of follow-up. With no irregularities and bulging of the superior calices (arrows) but retrograde contrast reflux.