Large renal stone with ureteral stone caused by 15 years of forgotten stent

Abstract

Introduction: Ureteral stents are commonly placed in urologic surgeries, and are especially indispensable in endourologic surgeries. But if it remains for more than 6 months, the probability of migration and calculus formation of the stent increases substantially. Case description: A 57-year-old female came to the urology outpatient clinic due to left flank pain. She had a history of open left nephrolithotomy 15 years ago and had ureteral stent placed. She also had a history of open vesicolithotomy surgery 4 years ago and was told to have a follow-up surgery for the remaining kidney stone but she didn’t come because of the limited level of local medical services and her pain tolerance. NCCT study showed moderate left hydronephrosis with a high volume renal stone measuring 60x35x20 mm (HU 1.021), two proximal ureteral stones measuring 40x10x10 mm (HU 1.021) and 60x5x5 mm (HU 1.021) with ureteral stent shadow in the center. She had elevated urea nitrogen and creatinine levels, microscopic hematuria, leukocyturia, and positive urine bacteria. The patient underwent percutaneous nephrolithotomy (PCNL) with endoscopic combined intra-renal surgery (ECIRS) for stone removal. Postoperative recovery was successful with no residual stones and significant pain relief. Conclusion: The case underscores the need for patient compliance, adequate practitioner counseling, and timely medical attention. The prevention of complications is the best treatment, and multimodal endourologic approaches can safely remove forgotten, encrusted double J stents.