Impacted Ureteral Stones Research Articles

Medical expulsive therapy symptomatic aggravation in blind right orthotopic ureterocoele and contralateral impacted left ureteral meatus stones: A Case Report

A ureterocoele with stone may present with recurrent flank pain and urinary tract infection. Medical expulsive therapy (MET) may be associated with symptomatic aggravation when there is ureteric obstruction or stone impaction. The definitive treatment is by deroofing and retrieval of the stone endoscopically or by open intravesical approach. We report a case of symptomatic aggravation of right orthotopic blind ureterocoele stone and contralateral impacted left ureteral meatus stone following MET using tamsulosin who was treated by open deroofing and retrieval of stones. Case presentation: This is a 17-year-old lady who presented with recurrent suprapubic colicky abdominal pain that was aggravated by Medical Expulsive Therapy (MET) using tamsulosin but improves with opioid analgesics. Abdominopelvic ultrasound done before MET revealed bladder stone but the repeat ultrasound after the MET revealed bilateral ureterocoele with stones. A computerized tomographic scan urogram (CTU) revealed a right ureterocoele stone and bladder stone. She had bladder exploration with the finding of blind right orthotopic ureterocoele containing stone measuring 2.5cm x 3cm and an impacted peeping left ureteric meatus stone of 1.2x1 cm. She had deroofing of the right ureterocoele and retrieval of the stones bilaterally. The stitches and stents were removed and discharged on 9 and 10 postoperative days respectively. The postoperative period was uneventful. Conclusion: Medical expulsive therapy may be associated with symptomatic aggravation in blind orthotopic ureterocoele and sizeable impacted ureteral meatus stone. Findings of the Imaging studies may be conflicting and inaccurate. Deroofing of the ureterocoele and stone retrieval is associated with a good outcome.

Development and validation of a preoperative nomogram for predicting patients with impacted ureteral stone: a retrospective analysis

BackgroundTo develop and validate a practical nomogram for predicting the probability of patients with impacted ureteral stone.MethodsBetween June 2020 to March 2021, 214 single ureteral stones received ureteroscopy lithotripsy (URSL) were selected in development group. While 82 single ureteral stones received URSL between April 2021 to May 2021 were included in validation group. Independent factors for predicting impacted ureteral stone were screened by univariate and multivariate logistic regression analysis. The relationship between preoperative factors and stone impaction was modeled according to the regression coefficients. Discrimination and calibration were estimated by area under the receiver operating characteristic (AUROC) curve and calibration curve respectively. Clinical usefulness of the nomogram was evaluated by decision curve analysis.ResultsAge, ipsilateral stone treatment history, hydronephrosis and maximum ureteral wall thickness (UWTmax) at the portion of stone were identified as independent predictors for impacted stone. The AUROC curve of development and validation group were 0.915 and 0.882 respectively. Calibration curve of two groups showed strong concordance between the predicted and actual probabilities. Decision curve analysis showed that the predictive nomogram had a superior net benefit than UWTmax for all examined probabilities.ConclusionsWe developed and validated an individualized model to predict impacted ureteral stone prior to surgery. Through this prediction model, urologists can select an optimal treatment method and decrease intraoperative and postoperative complications for patients with impacted ureteral calculus.

The impact of preoperative percutaneous nephrostomy as a treatment strategy before flexible ureteroscopy for impacted upper ureteral stones with hydronephrosis.

BackgroundThe treatment of impacted upper ureteral stones with hydronephrosis remains a challenge for urologists. The current study aimed to evaluate the impact of preoperative percutaneous nephrostomy (PNS) as a treatment strategy before flexible ureteroscopy (f-URS) of asymptomatic impacted upper ureteral stones with hydronephrosis.MethodsThis multicenter retrospective study included patients who underwent PNS (group A, n=61) and those who did not (group B, n=75) before f-URS for asymptomatic impacted upper ureteral stones with hydronephrosis. Impacted ureteral stones are defined as those that remain in one position for >2 months. Operative outcomes, including stone-free rate, operation time, postoperative hospital days, and complication rate, were evaluated.ResultsThere were no significant differences in age, sex, and stone size between the two groups except in the grade of hydronephrosis, with group A having more cases of advanced hydronephrosis than group B. The stone-free rate was significantly higher in group A than in group B [95% vs. 77% (P=0.004)]. However, there were no significant differences between the groups in operation time [55 vs. 55 min (P=0.84)], postoperative fever [5% vs. 5% (P=1.00)], and postoperative hospital days [2 vs. 2 days (P=0.44)]. In group A, preoperative PNS placement was performed 4 days before f-URS, and the PNS was removed postoperatively on the same day of the f-URS. Additionally, subgroup analysis was performed in cases of grade 2 and 3 hydronephrosis. A total of 110 patients, 60 who underwent f-URS with PNS and 50 who underwent f-URS without PNS, were included. The stone-free rate was significantly higher in f-URS with PNS than in f-URS without PNS [95% vs. 76% (P=0.005)]. However, no significant differences were found between the groups in operation time, ureteral injury, postoperative fever, and postoperative hospital days.ConclusionsAt grade 2 or 3 hydronephrosis, preoperative PNS as a treatment strategy for a few days prior to f-URS for impacted upper ureteral stones improved the stone-free rate without increasing the operation time and postoperative length of hospital stay.

Surgical and radiological predictive factors for ureteric stricture formation in patients treated with ureteroscopy for ureteric stones

Background Ureteric stricture is a potential complication of impacted ureteric stones. This study investigates surgical and radiological factors that could predict ureteric stricture formation after ureteroscopic treatment of impacted ureteric stones. Materials and method Intraoperative and radiological data for patients who underwent ureteroscopic treatment of ureteric stones impaction over a 5-year period were reviewed retrospectively. Patients who had previous ureteroscopic treatment or strictures were excluded. Results Between January 2014 and May 2019, 1,340 patients presented as emergency renal colic secondary to ureteric stones. A total of 297 ureteroscopy procedures were performed for impacted calculi. The mean age was 53 years. The stricture rate was 3.3%. Analysis of radiological and surgical factors revealed that the degree of hydronephrosis, residual fragments and intraoperative ureteric injury were significant predictors for stricture formation (p = 0.018, 0.01 and 0.02, OR = 10, 47 and 1776, respectively). None of the other factors significantly predicted ureteric stricture formation. Conclusion Our study found the presence of severe hydronephrosis, residual stone fragments after surgery and intraoperative ureteric injury are significant predictive factors for ureteric stricture formation. The high-risk patients should be monitored with routine postoperative renal ultrasound.

Predictive Factors for Requirement of Ureteral J Stenting in Ureteroscopic Treatment of Distal Ureteral Stones.

We aimed to investigate the factors predicting the need for ureteral J stent placement in the treatment of distal ureteral stones by ureteroscopy (URS). Between January 2007 and June 2018, 550 consecutive patients who underwent URS with the diagnosis of distal ureteral stone disease were evaluated in a single center. The patients were divided into two groups as; group 1 who received a ureteral J stent, and group 2 without ureteral J stent. The two groups were compared in terms of possible preoperative, perioperative and postoperative risk factors. History of systemic disease, stone disease and extracorporeal shock wave lithotripsy (SWL) were significantly higher in group 1 (P<0.001, P=0.009, P=0.016). The operation time was longer in group 1 (P<0.001). The rate of impacted stones was higher in group 1 (61.7% vs 15.6%; P<0.001). In multivariate analysis, co-morbidities, previous SWL history, presence of impacted ureteral stone and prolongation of the operation time were found to be statistically significant in predicting ureteral J stent placement. In the treatment of distal ureteral stones by URS, not only perioperative complications, prolongation of the operation time, and the presence of residual stones but also preoperative factors, such as systemic disease, and impacted ureteral stones should be considered as predictive factors in assessing the need for a ureteral J stent and to avoid unnecessary stent procedures.

Time dependant functional and morphological recovery of the kidney after relief of obstruction in patients with impacted ureteral stones.

To assess the course of functional and morphological recovery of the kidney following the relief of obstruction with ureteral JJ stent in cases with unilateral impacted stones. A total of 42 adult patients who were admitted to our clinic with unilateral obstructing impacted ureteral stones requiring JJ stent placement were included in the study. The course of functional recovery was assessed by evaluating the serum creatinine levels, renal resistive index (RRI) values and urinary levels of kidney injury molecule-1, neutrophil gelatinaseassociated lipocalin as well as microalbumin before at 1 day, 1 week and 4 weeks after JJ stent placement. Course of morphologic recovery was evaluated by evaluating the degree of hydronephrosis, kidney size, perirenal straining and ureteral diameter. Our results showed that all relevant parameters began to decrease after 24 hours and continue to normalize during 1 week evaluation; majority of these variables indicating the functional and morphological recovery were in normal range after 4 weeks. Decompression of the obstructed kidneys with JJ stent placement in patients with impacted ureteral stones was found to be effective enough with recovery of normal renal functional and morphological status after a minimum time period of 4 weeks. Morphological recovery of affected kidneys following JJ stenting was obtained with a significant difference between baseline and 1-month evaluation findings (p = 0.001, p < 001, p < 001, respectively). KIM-1 excretion began to decline to normal levels after 4 weeks (3.52 ± 0.99 ng/ml versus 2.84 ± 0.66 ng/ml, p < 0.001). The same findings were observed for the urinary excretion levels of NGAL, which normalized at the 1-month evaluation (604.55 ± 140.28 ng/ml versus 596.87 ± 80.17 ng/ml p = 0.895). Urinary microalbumin excretion levels however remained high even until 1-month follow-up with a statistically significant difference when compared with the normal excretion values (p < 0.001). There was a statistically significant difference in RRI values between baseline and 1-month follow-up findings in obstructed kidney (p < 0.001). Elective management of the obstructing impacted ureteral stone(s) will be safer with limited risk of infective complications after functional and morphological normalization in such kidneys following 4 weeks of JJ stent placement.

P0284 - Preoperative percutaneous nephrostomy before flexible ureteroscopy for impacted ureteral stone is effective on stone-free rate and ureteral injury

P0284 - Preoperative percutaneous nephrostomy before flexible ureteroscopy for impacted ureteral stone is effective on stone-free rate and ureteral injury

Is there any predictive value of the ratio of the upper to the lower diameter of the ureter for ureteral stone impaction?

Background:We aimed to determine if the ratio of the upper to the lower diameter of the ureter could have any predictive value for ureteral stone impaction.Materials and methods:Patients who had a solitary unilateral ureteric stone, determined by noncontrast computerized tomography, were assessed if they had undergone ureteroscopic lithotripsy. A total of 111 patients, 84 males (76%), and 27 females (24%), were recruited to the study. Demographic data of the patients and preoperative radiological parameters based on noncontrast computerized tomography were recorded. The impaction status was also assessed during the operation.Results:Of the 111 patients, ureteral stones in 63 (57%) patients were determined to be impacted, and ureteral stones in 48 (43%) were nonimpacted. Impacted stones were more common in older patients, female patients, and patients with an American Society of Anesthesiologists score of 2.Conclusions:Significant relationships were found between the impaction status and transverse stone length, longest stone length, upper diameter of the ureter, ratio (upper diameter of the ureter/lower diameter of the ureter), and anteroposterior diameter of the pelvis. These parameters were higher in patients with impacted stones.

Development of a Novel Nomogram and a Simple Scoring System Using Ureteral Jet Flow to Predict Impacted Ureteral Stone.

Purpose: To examine the efficacy of ureteral jet flow measured by Doppler ultrasonography (USG) together with radiological parameters obtained by noncontrast enhanced CT in predicting whether a ureteral stone is impacted. Materials and Methods: A total of 178 patients that met the criteria were included in the study. Stone size, location, grade of hydronephrosis, HU values of the stone and the proximal and distal parts of the stone, and ureteral wall thickness (UWT) were obtained from noncontrast enhanced abdominal CT images. Ureteral jet flows (Vmax) were measured and recorded by Doppler USG. Thirty-eight cases in whom the guidewire or opaque contrast material could not pass beyond the stone were included in the impacted ureteral stone (IUS) group, whereas the remaining 140 patients constituted the non-IUS (non-IUS) group. Results: Significant independent predictors of IUS were determined as stone size (odds ratio [OR]: 2.23, p = 0.020), ureteral HU value under the stone (OR: 1.11, p = 0.014), UWT (OR: 5.66, p = 0.009), anteroposterior diameter (OR: 1.23, p = 0.033), and the Vmax value of the stone side (OR: 0.76, p = 0.011). The proposed scoring system predicted IUS with 89% sensitivity and 91% specificity at a cutoff value of 11.5. Conclusion: Determining whether a ureteral stone is impacted is important in deciding on the optimal treatment modality. The nomogram and scoring system that we created based on the data that were obtained with noninvasive methods can predict IUS with high sensitivity and specificity.

The effectiveness of percutaneous nephrolithotomy for the treatment of large impacted upper ureteral stones

Objective: To compare the efficacy of semi-rigid or flexible ureteroscopic surgery and percutaneous nephrolithotomy, which is the standard method for the surgery of ≥2 cm upper ureteral impacted stones .&#x0D; Materials and Methods: The data of 123 patients who underwent stone surgery for ≥2 cm impacted ureteral stones in the upper ureter in our clinic were retrospectively analyzed. The patients were divided into two groups as ureteroscopic surgery group (URS, n = 59) and percutaneous nephrolithotomy group (PNL, n = 64) according to the type of operation. Patients with stones impacted in the ureter at the level between the L4 vertebra and ureteropelvic junction were included in the study. Preoperative demographic data and postoperative results of the patients in two groups were compared.&#x0D; Results: Average operation time was similar in both groups (p = 0.147). Mean hospital stay was significantly higher in the PNL group compared to the URS group (3.28 ± 0.57 days vs 1.11 ± 0.32 days, p = 0.001). Mucosal injury was developed in 10 (16.9%) patients in the URS group during the operation, while it was only 3 (4.7%) in the PNL group (p = 0.027). Postoperative urinary tract infection development was found to be similar in URS and PNL groups (8.5% vs 4.7%, p = 0.479). Postoperative stone-free rate was found to be significantly higher in the PNL group compared to the URS group (95.3% vs 79.7%, p = 0.008).&#x0D; Conclusion: PNL is a very effective and safe procedure in the surgical treatment of stones ≥2 cm in diameter impacted in the upper ureter. The complication rate of PNL is comparable with URS; however, it is seen that the PNL is more advantageous than URS in terms of postoperative total stone-free rate.

Can shock wave lithotripsy lead to impaction of ureteral stones?

One of the underlying reasons for shock wave lithotripsy (SWL) resistance is the ureteral stone impaction. This study aimed to investigate the accuracy of the hypothesis, suggesting that SWL per se can be the reason for ureteral stone impaction. One hundred and seventy-six patients were enrolled in the study. Data of the patients (N.=50) treated with SWL and subsequent semirigid ureteroscopic laser lithotripsy (SULL) in our center between January 2014 and January 2020 were retrospectively reviewed compared with the data of the patients (N.=126) who underwent SULL without prior SWL treatment during the same period. Patients reported to have ureteral stone impaction during SULL were compared with those without stone impaction in terms of demographic parameters, stone characteristics and clinical data, including symptom duration and presence or absence of SWL history. The success rate of SULL was determined as 80.1% (141/176). Univariable analysis revealed statistically significant differences between the patients with and without stone impaction concerning stone diameter, stone volume, pre-SULL SWL history, symptom duration and ureteral wall thickness (UWT). Multivariable logistic regression analysis revealed that symptom duration and UWT were independent predictive factors for ureteral stone impaction. Symptom duration and UWT are independent predictors of ureteral stone impaction. Symptom duration and UWT should be considered during treatment planning and informed consent process before proceeding with SULL.

Ureteral Avulsion during Semirigid Ureteroscopy: A Single-Centre Experience.

Aims The aim of the study is to present our experience with the management of ureteral avulsions following semirigid ureteroscopy for ureteral stones. This is one of the largest series reported so far. Methods and Materials It is a retrospective and observational study done at Sri Ramachandra Institute of Higher Education and Research over the last 18 years. Results There were seven cases of ureteral avulsion following semirigid ureteroscopy. All patients were males with a mean age of 35.7 years. All had impacted stones, with proximal ureteric location in 6 patients and distal ureteric location in 1 patient. Five cases had two-point avulsions with loss of entire ureter. Two cases had one-point avulsion: one distal ureteric and the other mid-ureteric. Of the five cases with whole length ureteral avulsion, four were managed by classical ileal replacement of ureter and the the fifth case was managed by ileal replacement of ureter by the Yang–Monti technique. Of the two cases with one-point avulsion, one was managed by uretero-neocystostomy and the other by uretero-ureterostomy. All the patients had successful outcome. Conclusions Even though rare, ureteral avulsion can potentially happen especially when dealing with impacted ureteric stones. Being conscious of the possible occurrence of this serious complication during any difficult ureteroscopy and exercising utmost care during the procedure are important preventive measures. However, this catastrophe can be successfully managed by either immediate definitive repair or in a staged manner.

Antegrade mini-percutaneous flexible ureteroscopy versus retrograde ureteroscopy for treating impacted proximal ureteric stones of 1–2 cm: A prospective randomised study

ABSTRACT Objectives To prospectively assess the safety and effectiveness of antegrade mini-percutaneous (miniperc) ureteroscopy (URS) and compare it with the conventional retrograde URS (RURS) approach in treating impacted proximal ureteric stones of 1–2 cm. Patients and methods The study included 60 patients admitted to the Department of Urology, Alexandria Main University Hospital, presenting with impacted proximal ureteric stones of 1–2 cm. Patients were randomly divided into two groups: Group A, were treated with RURS using a semi-rigid or flexible ureteroscope to access the stone; and Group B, were treated by antegrade miniperc URS, were a 14-F renal tract was obtained to pass a ureteric access sheath, then a flexible ureteroscope was used going downwards to the stone. Holmium laser was used for stone fragmentation. A JJ stent was inserted in all cases. Follow-up with non-contrast computed tomography was performed after 2 weeks. Results Both groups were comparable in terms of patient demographics and stone criteria. The stone-free rate was significantly higher in Group B (83.3%) compared to Group A (60%). The mean (SD) operative time was significantly shorter in Group A vs Group B, at 64.7 (±17.7) vs 112.0 (±15.3) min; while the mean lithotripsy time was comparable between the groups. The mean radiation exposure time was significantly less in Group A (11 s) compared to Group B (200 s). Both groups where comparable concerning minor complications, with no major complications. Conclusion Antegrade miniperc flexible URS is safe and more effective than RURS for treating large impacted proximal ureteric stones. Abbreviations ESWL: extracorporeal shockwave lithotripsy; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; miniperc: mini-percutaneous; PCNL: percutaneous nephrolithotomy; PCS: pelvi-calyceal system; SFR: stone-free rate; (R)URS: (retrograde) ureteroscopy

Non-invasive preoperative assessment of ureteral stone impaction using peri-calculus ureteral thickness on Non-Contrast CT (NCCT) scan: A prospective Study

Background: Ureteral stone can be measured on the NCCT scan as peri-calculus ureteral thickness. If this depicts significant calculus impaction, the patient could be counseled regarding intra-operative risk and incomplete stone clearance. The present study was planned to evaluate the use of NCCT in patients with ureterolithiasis for the prediction of a favorable clinical outcome. Materials and methods: Patients who underwent ureterorenoscopy for ureteric calculus with pre-operative NCCT scan were included and intraoperative data were recorded. Operating surgeons were blinded for proximal ureteric wall thickness (p-UWT), peri-calculus ureteric wall thickness (p-CUT), and distal ureteric wall thickness (d-UWT) values. The guidewire was negotiated before each URS. Stone was considered impacted if guidewire could not be negotiated in 2 attempts. Intra-operative stone impaction score (SIS) assigned on a scale of 0 (dislodged spontaneously), 1 (dislodged with saline pressure), 2 (dislodged after lithotripsy), 3 (fragments impacted in edema) and 4 (open). Intra-operative findings were correlated to preoperative NCCT measurements of ureteral thickness. Other variables like duration of symptoms, hydronephrosis, stone size in the longest dimension, and stone location were also recorded. Results: Of total patients 108 patients, 70 patients had non-impacted calculus and 38 patients had impacted calculus. Patients with an impacted calculus had significantly higher p-UWT (9.76 ±3.11mm), p-CUT (6.82±2.57mm), and d-UWT (6.26±2.28mm) as compared to non-impacted. There was a positive correlation in SIS with p-UWT, p-CUT, and p-DWT in both impacted and non-impacted groups. Conclusion: Pre-operative ureteric wall thickness in proximal, peri, and distal to calculus can predict intraoperative risk and impaction of calculus.

What Guidewire Is the Best for Bypassing an Impacted Ureteral Stone?

Introduction and Objectives: To determine the optimal guidewire for bypassing an impacted ureteral stone. Materials and Methods: Three different benchtop models of varying impaction (300, 362, and 444 mm Hg pressure) were used to compare the ability of 13 different guidewires to bypass an impacted ureteral stone. In the first and second models, we recorded the maximum force required to bypass the stone. In the first model (300 mm Hg) 10 new wires for each of the 13 types were advanced past a ureteral stone using a series 5 digital force gauge. In the second model (362 mm Hg), the top 5 performing guidewires were similarly tested. In the third model (444 mm Hg), 5 attending urologists and 5 urology residents (blinded to wire type) compared the 13 guidewires and rated the wire performance using a Likert scale. Statistical analysis was performed with analysis of variance and the chi-square test. Results: In the first model, there was a significant difference between wires (p < 0.001) with the lowest mean force to bypass a stone seen in the Glidewire (0.117 ± 0.02 lbs) and HiWire (0.130 ± 0.01 lbs). Of the five wires tested in the second model, the Glidewire (0.24 ± 0.09 lbs) and UltraTrack (0.40 ± 0.35 lbs) both required less force than the other three wires (p = 0.018). In the third model, only two wires (Roadrunner and Glidewire) bypassed the impacted stone in 100% of trials. When comparing standard, hybrid, and hydrophilic wires, the hydrophilic had the highest success rate (standard = 0%, hybrid = 36.67%, and hydrophilic = 70.67%; p = 0.000) and Likert score (standard = 1.03, hybrid = 2.38, and hydrophilic = 3.24; p = 0.000). Hydrophilic wires required the least time to bypass the stone (hybrid = 82.81 seconds vs hydrophilic = 45.37 seconds, p = 0.000). Conclusions: In this benchtop study, standard wires performed poorly and hybrid wires were not as effective as hydrophilic wires. The Glidewire required the least force, the shortest insertion time, and had the highest surgeon satisfaction rating.

Recurrent Kidney Stones and Parathyroid Adenoma

A 29-year-old female presented to the out-patient Department of Surgery with history of recurrent kidney stones. Patient was on medical management for recurrent kidney stones for the last 5 years and even had undergone uretroscopic lithotripsy (URSL) for impacted left ureteric stone. Patient was evaluated in the past but no primary diagnosis was made. We evaluated and the patient was found to have hypercalcaemia (11.8 g/dl) with raised parathyroid hormone (PTH) levels.

Efficacy of semirigid ureterorenoscopy with the use of ureteral acsess sheath in the treatment of impacted ureteral stones: A prospective randomized study

Aim: To investigate the advantages of using Ureteral Access Sheat (UAS) with semirigid ureterorenoscopy in patients with impacted ureteral stones. Materials and Methods: One hundred and 22 adult patients that presented to our clinic with the complaint of impacted stones in the middle and upper parts of the ureter and were scheduled for surgical treatment. The procedure was performed without UAS in control group and using UAS in study group. Results: No significant difference was found between the two groups in terms of age, gender, stone disease history, presentation complaint, stone side, size, density and localization, degree of renal hydronephrosis, complications and length of hospital stay. Stone migration, operation time, duration of fluoroscopy, and postoperative additional surgical intervention rates were significantly lower in the UAS group [26.2% (n = 16) vs 11.5% (n = 7), p = 0.037; 35.46 ± 5.3 min vs 25.56 ± 4.2 min, p < 0.001, 5.50 ± 0.86 sec vs 3.24 ± 0.69 sec, p < 0.001; and 19.7% (n = 12) vs 6.6% (n = 4), p = 0.032, respectively]. The operation was successful in 48 (78.7%) patients in the control group and 57 (93.4%) in the UAS group, with a statistically significant difference (p = 0.019). Conclusion: The use of UAS in the treatment of middle-upper impacted ureteral stones presents as an advantageous method due to the shorter operation time and lower rates of intraoperative stone migration and high success rates of the operation.

Laparoscopic ureterolithotomy in large impacted upper ureteric stones

Laparoscopic ureterolithotomy in large impacted upper ureteric stones

Laparoscopic ureterolithotomy in large impacted upper ureteric stones

Laparoscopic ureterolithotomy in large impacted upper ureteric stones

Double J Stent Mislocation—Case Report

Double J Stents (DJS) have been universally used in endourologic practices worldwide for the treatment of occluded ureters. DJS dislocation is considered very rare. We report an interesting case of a closed tip double J stent (DJS) misplacement in a patient that suffered renal colic’s due to a small impacted ureteric stone. During the insertion procedure the ureteral stent perforated the ureter and passed into the inferior vena cava. It was incidentally diagnosed when the patient underwent a follow up CT scan 2 months later to review and confirm the passing of the stone. The stent was successfully removed with flexible cystoscopy under fluoroscopy and with interventional radiology supervision. The patient was discharged after that and remained asymptomatic after the event. Objective of this article is to review the literature and raise awareness of the risk of JJ Stent dislocation and its potential complications.