JJ Stent Research Articles

Double J stent is superior to externally draining ureteric stent in enhancing recovery after kidney transplantation - A prospective cohort study.

Routine intraoperative ureteric stenting lowers the rate of urological complications after kidney transplantation. However, there is no consensus about the optimal stent design and duration. The aim of this prospective cohort study was to compare the influence of double J (JJ) stents and externally draining percutaneous (PC) stents on the early quality of recovery after living donor kidney transplantation. A prospective cohort study was performed in two consecutive cohorts of 40 patients who underwent living donor kidney transplantation at the Radboud university medical center between April 2016 and October 2017. The first cohort of 40 patients received a 6-French externally draining PC stent. The second cohort of 40 patients received a 6-French/14cm JJ stent. We compared the influence of the stent design on the quality of early post-operative recovery (measured by the Quality of Recovery-40 questionnaire) and the length of hospital stay. Patients with a JJ stent scored significantly better on the Quality of Recovery score on the third and fifth postoperative day, when compared to patients with a PC stent. Furthermore, in comparison to patients with a PC stent, patients with a JJ stent were earlier mobilising and independent in daily activities, resulting in a shorter length of hospital stay. The number of postoperative urological complications was comparable between the two groups. The use of JJ stents during living donor kidney transplantations improves the postoperative recovery and shortens the length of hospital stay, when compared to PC stents without compromising the number of postoperative urological complications.

UP050 - Predictive value of ureteral wall thickness on the likelihood of JJ stent placement in obstructing proximal ureteral calculi

UP050 - Predictive value of ureteral wall thickness on the likelihood of JJ stent placement in obstructing proximal ureteral calculi

Effect of JJ stent on outcomes of extracorporeal shock wave lithotripsy treatment of moderate sized renal pelvic stones: A randomized prospective study

PurposeTo evaluate the effect of JJ stents on SWL treatment of moderate (15–25mm) renal pelvic stones. Materials and methodsBetween January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. ResultsThere was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, p=0.002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (p<0.001 and p<0.001, respectively). In non-stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (p=0.004). ConclusionsPre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption.

A Comparison of Clinical Outcomes of Operating Room Versus Office-based Ureteral Stenting With the Novel Use of Nitrous Oxide Sedation

ObjectivesTo examine the safety and effectiveness of placing ureteral stents in an office-based setting vs in the operating room (OR). MethodsA retrospective chart review was performed to examine outcomes, specifically complication rate, unanticipated hospitalizations, and stent failures, when patients received JJ stents in the clinic procedure suite, using local analgesia and/or nitrous oxide gas analgesia, compared to patients who had ureteral stents placed in the OR, typically with general anesthesia. Additionally, multivariable analysis was performed to determine predictors of complications. ResultsAround 565 procedures were performed in the clinic and 179 were performed in the OR. The complication rate for the clinic group was 4.1%, compared to 7.8% in the OR group. Unplanned admissions to the hospital occurred after 3.0% of clinic procedures and 9.5% of OR procedures. Stent placements failed in 1.1% of clinic procedures and 0.56% of OR procedures. Clinic procedure time was 10 minutes vs 12 minutes in the OR (P <0.01). Clinic vs OR setting was not predictive of complications (P = 0.99). We did not identify factors that impacted complication rate in ureteral stent placement in the clinic vs OR setting. Notably, the procedure time for a clinic stent placement was significantly shorter than the OR stent placement. ConclusionsThis study demonstrates excellent outcomes with a novel approach to a standard procedure, with shorter procedure time and no difference in complication rates.

Cost-effectiveness analysis of a single-use digital flexible cystoscope for double J removal.

The novel single-use digital flexible cystoscope Isiris™ has been developed to perform in-office JJ stent removal, without the need of special equipment nor limitations linked to the disinfection of a reusable device. The aim of our study was to perform a cost-effectiveness analysis of Isiris™ in our institution. A total of 127 consecutive patients undergoing in-office stent removal with Isiris™ were prospectively included in study. After each procedure, the urologist filled a questionnaire specifically developed to evaluate the efficiency of the device and the invasiveness of the procedure. We performed a cost analysis of the main variables involved in JJ removal using Isiris™ versus the traditional Storz™ reusable flexible cystoscope used for all our previous patients. The procedure was successful in all cases except for one, where the device did not work due to the failure of the grasper and had to be replaced. Overall, the performance of Isiris™ was judged by the physician "very good" and "good" in 90.6% of the cases. Both median pain and invasiveness felt by the patient were 0 (range = 0-8). The mean cost of procedure was estimated at €361 for in-office stent removal with Isiris™, and €1.126.8 for stent removal in operatory room with a reusable flexible cystoscope. Considering the 127 procedures performed in office, 64 h of operatory room time was saved. In institutions where JJ removal is performed in the operatory room, Isiris™ leads to a significant advantage in terms of money saved per procedure, operatory room time gained and patient satisfaction.

Forgotten Double-J Ureteral Stents: Prevalence, Risk factors and Complications

Background: Ureteral JJ stents (DJS) are a common part of urological practice and are used for the management of upper urinary tract obstruction and ureteral surgery, despite their advantages; ureteral stents are not without possible morbidity. Objective: This study aimed to record the prevalence and possible reasons behind neglected DJS and its complications. The difficulties associated with their removal and risk factors correlate with these difficulties. Patients and Methods: A cohort study including 517 patients presented with fixed DJS presenting to Department of Urology, Al-Azhar University Hospitals; Cairo; Egypt. With neglected DJS (indwelling for more than 6 months). We noted the complications of neglected stents (urinary tract infection, gross hematuria, encrustation, migration and stent fragmentation), the treatment modalities and risk factors for these complications. Results: From the entire patients, 239 (46.2%) had a neglected stent with mean stenting duration 11.11 ± 8.6 months. A total of 26.8% of patients received urine acidification, 26.4% were stone formers, 32.2% presented with urinary tract infection (UTI) and 33% had gross hematuria. Encrustations on the stent were recorded in 17.2% of patients and fragmented stent in 4.6% and 2.5% migrated stent up. The stent was removed by cystoscopy in 201 cases (84.1%). Other cases needed combined endoscopic and/or open surgical procedures. Lack of urinary acidification was a significant risk factor for UTI and complex interventions for stent removal (P = 0.013 and 0.017, respectively). Stent fragmentation were more likely with longer duration of stenting (P = > 0.001). Conclusion: Neglected DJS are associated with significant morbidity, urine acidifications is protecting against complications.

Forgotten Double-J Ureteral Stents: Prevalence, Risk factors and Complications

Background: Ureteral JJ stents (DJS) are a common part of urological practice and are used for the management of upper urinary tract obstruction and ureteral surgery, despite their advantages; ureteral stents are not without possible morbidity. Objective: This study aimed to record the prevalence and possible reasons behind neglected DJS and its complications. The difficulties associated with their removal and risk factors correlate with these difficulties. Patients and Methods: A cohort study including 517 patients presented with fixed DJS presenting to Department of Urology, Al-Azhar University Hospitals; Cairo; Egypt. With neglected DJS (indwelling for more than 6 months). We noted the complications of neglected stents (urinary tract infection, gross hematuria, encrustation, migration and stent fragmentation), the treatment modalities and risk factors for these complications. Results: From the entire patients, 239 (46.2%) had a neglected stent with mean stenting duration 11.11 ± 8.6 months. A total of 26.8% of patients received urine acidification, 26.4% were stone formers, 32.2% presented with urinary tract infection (UTI) and 33% had gross hematuria. Encrustations on the stent were recorded in 17.2% of patients and fragmented stent in 4.6% and 2.5% migrated stent up. The stent was removed by cystoscopy in 201 cases (84.1%). Other cases needed combined endoscopic and/or open surgical procedures. Lack of urinary acidification was a significant risk factor for UTI and complex interventions for stent removal (P = 0.013 and 0.017, respectively). Stent fragmentation were more likely with longer duration of stenting (P = > 0.001). Conclusion: Neglected DJS are associated with significant morbidity, urine acidifications is protecting against complications.

Transvaginal repair of ureteral transection post gynecological surgery: a case report

Introduction: Ureteral injuries are relatively common in gynecological procedures. The repair of such injuries has traditionally been done through open surgery; however, minimally invasive techniques have become an option in some cases. We report the case of a ureteroureteral anastomosis successfully transvaginally approached. Case report: a 70-year-old woman developed hydronephrosis and acute renal failure after vaginal hysterectomy, parametrectomy, McCall culdoplasty, sacrocolpopexy, posterior colpoplasty and perineoplasty. She was reoperated, and had bilateral ureteral injuries correctly identified and repaired through the vaginal route. Discussion: Difficulties encountered during transvaginal surgery include ureter identification and the narrow surgical field. In order for a vaginal repair to be performed, surgeons must have expertise with vaginal surgery and know the anatomy of the ureter as seen through the vagina. Additionally, JJ stents can be used to facilitate repair. Conclusion: Vaginal repair of ureteral injuries is feasible and has potentially less morbidity than the standard abdominal approaches, but further studies are needed in order to determine its efficacy and complication rates.

Laparoscopic retroperitoneal approach for retrocaval ureter in children.

Retrocaval ureter (RCU) is a rare congenital anomaly and published data on pediatric laparoscopic management are poor. The aim of this study was to report our experience of retroperitoneal laparoscopic approach for management of RCU in children. A retrospective review of data from patients treated for RCU between 2002 and 2018 in our institution was performed. All patients were positioned in a flank position and underwent a three-port (5-mm optical trocar and two 3-mm trocars) laparoscopic retroperitoneal ureteroureterostomy. Anastomosis was made by 6/0 absorbable sutures. A JJ stent was always inserted. Five patients with a median age of 94months (5-152) were operated on and followed up for a median time of 103months (46-201). Median operating time was 200min (160-270). No conversion and no transfusion occurred. Median hospital stay was 2days (1-4). Ureteral stent was removed after 52days (47-82). Complications included pyelonephretis (N = 1). In all cases, hydronephrosis decreased postoperatively. Retroperitoneal laparoscopic approach for RCU is safe and effective in children. Our video demonstrates different patients with specific surgical details to show how to manage these children. The global vision of the upper tract by laparoscopy leads to optimal management of these children even if the anomaly was not detected preoperatively.

Resultados de LEOCH con o sin catéter para el tratamiento de cálculos en la pelvis renal: un estudio aleatorizado

PurposeTo evaluate the effect of JJ stents on SWL treatment of moderate (15-25mm) renal pelvic stones. Materials and methodsBetween January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. ResultsThere was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, P=.002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P<.001 and P<.001, respectively). In non- stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P=.004). ConclusionsPre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption.

Reflective Practice About Retroperitoneal Laparoscopy in Comparison to Open Surgery for Ureteropelvic Junction Obstruction Repair in Children Less Than 1 Year of Age.

Introduction: The interest in laparoscopy in the treatment of ureteropelvic junction obstruction (UPJO) in children under 12 months of age remains controversial. The aim of this study is to evaluate feasibility and benefits of retroperitoneal laparoscopy (RL) compared to open surgery in this age group.Materials and Methods: Between January 2012 and May 2017, we performed 222 pyeloplasties: 144 by laparoscopy and 78 by open surgery. From 2012, the choice of operative technique was decided according to the laparoscopic experience of the surgeon; two surgeons operated laparoscopically on all children <12 months of age, while others operated using posterior lumbotomy (PL). The RL is standardized and performed by 3 trocars (5, 3, 3). Pre, per and postoperative parameters were analyzed retrospectively. Statistical tests: Pearson, Fisher, Student and Mann-Whitney.Results: During this 5-year period, 24 RL and 53 PL were included with a median follow-up of 27 months (5–63). In the LR group, postoperative drainage was performed by JJ (13 cases) and external stent (11 cases). No conversion has been listed in this group. In each group there was one failure that needed redo pyeloplasty. Duration of hospitalization and intravenous acetaminophen use were significantly lower in the RL group (2.8 vs. 2.3 days, p = 0.02, respectively) while operating time was significantly longer (163 vs. 85.8 min, p = 0.001). The postoperative complication rate was statistically identical in each group (urinary tract infection, wall hematoma, hematuria…).Conclusion: RL is feasible in children under 1 year of age in the hands of well-experienced surgeons with longer operative time but without added morbidity. Subject to the retrospective nature of our study, the RL seems to offer a benefit regarding duration of hospitalization and analgesics consumption.

Living with ureteric stents: a phenomenological study.

patients with ureteric stents (JJ stents) have reported symptoms such as voiding dysfunction, incontinence, depression and sexual dysfunction, which have impacted on their quality of life, since the procedure was first described by Zimskind in 1967. the aim of this study was to enhance understanding of the lived experience of having a ureteric stent. the research design used was hermeneutic interpretive phenomenology, underpinned by Heidegger's interpretive phenomenology. this phenomenological study found that ureteric stents have an impact on patients' quality of life. The five themes that emerged were: disruption to activities of daily life, burden on my physical body, burden on my mind, influence of time and influence of others. urological nurses can enhance the patient's experience of living with a ureteric stent by educating patients regarding stent symptoms and management, giving psychological support and advocating for the patient with adverse stent-related symptoms.

Management of ‘forgotten’ encrusted JJ stents using extracorporeal shockwave lithotripsy: A single-centre experience

ABSTRACTObjective: To evaluate the role of extracorporeal shockwave lithotripsy (ESWL) for the management of ‘forgotten’ encrusted stents.Patients and Method: This is a retrospective study of 133 patients with forgotten JJ stents, treated between January 2015 and January 2018. Encrustation was mainly found in the renal coil of the stent with distal concomitant encrustation in the vesical and/or ureteric segment. After laboratory and radiological assessment, treatment started with ESWL for the renal encrustation before successful extraction. Auxiliary endourological procedures were used for the encrusted vesical or ureteric segments. Failed cases underwent open surgery.Results: The mean (SD; range) JJ stent indwelling time was 25.84 (10; 14–70) months. In all, 96 (72.2%) patients were seen after treatment for stone disease. In total, 94 patients (70.7%) were managed by ESWL monotherapy, whilst in 36 (27%) additional endourological procedures were required before successful extraction including: cystolithotripsy 19 patients (52.8%), ureteroscopic lithotripsy eight (22.2%), and percutaneous nephrolithotomy nine (25%). Open surgery was required in only three patients (2.3%). A mean of 0.28 procedures per patient was required before smooth stent extraction. The encrusted stents were removed after the first, second, third, and fourth ESWL sessions in 44 patients (33.1%), 43 (32.3%), 26 (19.5%), and 17 (12.8%), respectively. Patients with forgotten indwelling JJ stents for >2 years had significantly larger and harder encrustation at both JJ coils.Conclusion: ESWL proved a feasible first-line treatment for forgotten encrusted JJ stents. The indwelling time of forgotten stents in the urinary tract is associated with greater encrustation burden, density and multiple sites of encrustation.Abbreviations: CLT: cystolithotripsy; ESWL: extracorporeal shockwave lithotripsy; HU: Hounsfield unit; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; PCNL: percutaneous nephrolithotomy; URL: ureteroscopic lithotripsy

MP23-09 PRE-PCNL INFECTION AND ITS EFFECT ON POST-PCNL OUTCOMES

INTRODUCTION AND OBJECTIVES:Details regarding infections treated before undergoing PCNL were added to the BAUS PCNL database in 2014. We analysed these data to assess the implications that pre-operative infection would have on the outcome of PCNL, especially for post-operative complications particularly regarding sepsis.METHODS:Data from the National UK PCNL database recorded between 2014-16 for patients with pre-operative treated infections were categorised into four groups:•patients who had received oral antibiotics•patients admitted for iv antibiotics•patients who required emergency drainage (either by JJ stent or nephrostomy)•patients who required an ITU admission for sepsisChi squared analysis was performed between patients with and without prior infectionsRESULTS:2630 patients were analysed. 1379 (52.4%) had no pre-PCNL infection (“Controls”). 1251 patients (47.6%) had prior treatment for infection, of whom 30.7% received at least one course of oral antibiotics, 6.9% required at least one admission ...

MP23-19 INTRODUCTION OF A NURSE LED STENT REMOVAL SERVICE USING THE SINGLE USE ISIRIS IN A TERTIARY REFERRAL STONE UNIT AND THE EFFECT ON PATIENT WAITING TIMES

INTRODUCTION AND OBJECTIVES:JJ stenting represents one of the most significant causes for patient discomfort and dissatisfaction following ureteroscopy. At the author’s institution, which is a larg...

Incidence of Bacteriuria in Adult Renal Stone Patients Having Ureteric Stents and Undergoing Extracorporeal Shock Wave Lithotripsy

AbstractBackground: To evaluate the effect of Extracorporeal Shock Wave Lithotripsy (ESWL) on the incidence of bacte-riuria in patients with JJ stents who had sterile urine prior to ESWL.Aim of Study: This study aimed to evaluate the effect of ESWL on the incidence of bacteriuria in patients with JJ stents who had sterile urine prior to ESWL.Material and Methods: The study was conducted between January and August 2015 in Aseer Central Hospital, Abha, Saudi Arabia. We prospectively recruited 126 patients who had JJ stents previously inserted for renal or ureteral stones. Elderly patients and those with chronic medical diseases and other risk factors were excluded. All the patients had negative urine culture just before ESWL. Urine cultures were done twice, immediately after ESWL and two weeks later to detect the presence of bacteriuria. Those who had one or two positive cultures for bacterial growth were labeled to be having bac-teriuria after ESWL, while those with negative cultures were labeled as negative for bacteriuria.Results: Out of 126 patients with JJ stents, 20.6% devel-oped bacteriuria after ESWL. The incidence of bacteriuria in females was higher than males (p=0.002). Duration since JJ stent insertion (54.3±11.4 days) and the number of JJ stents were found to be significantly associated with positive bacte-riuria (pConclusions: Incidence of bacteriuria in patients with renal stones with ureteric stents undergoing ESWL was 20.6%, which was comparable to that of patients with ureteric stents who did not undergo ESWL. Therefore, antibiotic prophylaxis in patients with ureteric stents undergoing ESWL may not be necessary, except in certain cases (i.e., female gender, several stents and their prolonged duration, as well as the multiple stones and their large size).

150 - Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial

Abstract The effects of ureteral stent diameters on ureteral stent-related symptoms were evaluated by using Turkish-validated Ureteral Stent Related Symptoms Questionnaire (USSQ). Datas on 126 patients underwent uncomplicated flexible ureterorenoscopy and 62 patients underwent uncomplicated semirigid ureteroscopy surgery without stent insertion (group 3) were collected. Patients were randomized preoperatively in a double-blind fashion to 4.8 French (group 1) and 6 French (group 2) ureteral JJ stents groups. The first follow-up visit was done at one week after surgery for all groups. Stents were removed on the third postoperative week for stented groups. The second follow-up visit was done at one week after stent removal for group 1 and group 2, and four week after surgery for group 3. Preoperative characteristics, operation time and hospitalization times were similar in both groups. Total USSQ scores were 91.9, 103.0, 44.2 at first visit and 54.3, 58.7, 28.5 at second visit in group 1, group 2, and group 3, respectively. At both first and second visits, the group 2 had significantly higher USSQ scores than the group 1 (p = 0.01 and p

Robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidneys: results of a multicentric study.

This multicentric study aimed to report our experience with robot-assisted laparoscopic pyeloplasty (RALP) in children with horseshoe kidney (HSK). The records of 14 patients (11 boys and 3 girls with an average age of 9years), who underwent RALP for repair of pelvi-ureteric junction obstruction (PUJO) in HSK in five international pediatric urology units over a 5-year period, were retrospectively reviewed. A dismembered pyeloplasty with no division of isthmus was performed in all the cases. The average operative time including docking was 143.5min (range 100-205). No conversions to laparoscopy or open surgery or intra-operative complications occurred. Patients were discharged on postoperative day 2 following catheter and drain removal. The JJ stent was removed at mean 33days postoperatively. Overall success rate was 92.8%. As for postoperative complications, we recorded a urinary tract infection (UTI) and stent-related irritative symptoms, managed with medical therapy, in two patients (II Clavien) and an anastomotic stricture in one patient needing surgical revision with no further recurrence (IIIb Clavien). At follow-up, all the patients (one after redo-surgery) reported complete resolution of symptoms, improvement of hydronephrosis on ultrasound and no residual obstruction on diuretic renogram. Our experience suggested that RALP in HSK is safe, feasible and with good medium-term outcomes in expert hands. An accurate pre-operative planning associated with a standardized technique is key points to achieve good surgical and functional outcomes in these challenging cases. The da Vinci robot technology offers the advantages of MIS procedures and overcomes the technical challenges of laparoscopic approach.

Percutaneous nephrostomy versus antegrade double-J stent placement in the treatment of malignant obstructive uropathy: a cost-effectiveness analysis from the perspective of the Brazilian public health care system.

ObjectiveTo compare two percutaneous techniques used in the treatment of malignant obstructive uropathy-antegrade double-J stent placement (JJ stenting) and percutaneous nephrostomy-in terms of their cost-effectiveness, from the perspective of the Brazilian public health care system.Materials and MethodsIn this cost-effectiveness analysis, we employed decision-analytic modeling. We calculated material costs from 2017 factory prices listed by the Brazilian Pharmaceutical Market Regulatory Board (for medications) and published in the journal Revista Simpro (for medical devices). Procedure-related costs were evaluated, as were the rates of technical and clinical success. Those measures were then used as inputs for a cost-effectiveness analysis comparing the two procedures.ResultsThe sample comprised 41 patients, of whom 16 underwent antegrade JJ stenting (26 procedures) and 10 underwent percutaneous nephrostomy (15 procedures). Patient records, radiology reports, and expense reports of the interventional radiology department of the public hospital where the study was conducted were analyzed retrospectively. There were no significant complications: one patient had low back pain, and one had a transient retroperitoneal hematoma. The mean procedure time was 24 min, and clinical success (improvement in serum creatinine and resolution of hydronephrosis) was achieved in 97.5% of the cases. The average cost of JJ stenting was significantly lower than was that of percutaneous nephrostomy (US$164.10 vs. US$552.20).ConclusionIn the absence of any clinical contraindications, antegrade JJ stenting is a suitable alternative to both percutaneous nephrostomy and retrograde stenting in patients with dilated renal collecting systems secondary to malignant ureteral obstruction, providing significant cost savings and high success rates.

Uretero-arterial Fistula by a Double-J Ureteric Stent in a Stented Internal Iliac Artery Aneurysm

We represent a-65-year-old male patient presented with indwelling left JJ stent for obstructed solitary kidney drainage. The obstruction was due to internal iliac artery aneurysm, had been managed by trans-femoral self-expandable coated endovascular stenting. This patient readmitted with recurrent attacks of hematuria with displaced JJ stent and rising serum creatinine twice. In the first admission, the patient was managed by JJ stent readjustment and Percutaneous Nephrostomy tube (PCN) and was discharged safely. Again, he presented with UAF associated with aggressive hematuria mostly due to vascular endoleak rupture. The patient developed severe sepsis and multiple organ dysfunction syndrome.