Investigation of Patients with Forgotten Double J Ureteral Stent and Their Management: A Case Series

Abstract

Background and Objective: Most forgotten ureteral stents (FUS), especially those more than one year old, require additional procedures, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL) or a combination of the above. Due to the importance of incrustation and complications of FUS on the kidney, which imposes a high financial burden on patients and the medical system, this study aimed to investigate the management of forgotten double-J ureteral stents. Materials and Methods: All patients who referred to Shahid Hashminejad and Firouzgar hospitals in Tehran, Iran from April 2020 to April 2022 due to a delay in removal of double-J ureteral stent for more than 3 months were included in the study. Patient information, including demographic and clinical data, was extracted from their files and entered into the checklist. Encrustation was graded based on the forgotten, encrusted, calcified (FECal) criteria. Written consent was obtained from all the patients. Results: In total, 70 patients and 89 procedures were examined. The mean age of the patients was 46.36±16.72 years, 84.3% of whom were male. The mean indwelling time of FUS was 13.17 months. The most common presenting complaints included dysuria (52.9%) and frequency (48.6%). It is noteworthy that 77.9% of patients had hydronephrosis and 25.7% had UTI. Moreover, 65.2% of patients were informed about the timely removal of ureteral stent. The most used procedures for FUS removal were ureteroscopy (53.9%), transurethral lithotripsy (32.6%), and PCNL (13.5%). The majority of incrustations (55.1%) were classified as grade 1 and 22.5% as grade 2. Conclusion: The results of this study showed that the endourologic treatment of forgotten ureteral stents in one session was feasible and safe. However, additional treatments, such as ESWL and PCNL, were sometimes needed, although finally these patients were managed endourologically.