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The first report of 3 forgotten encrusted double J stents in the same ureter: An endourology nightmare!
Authors:Ahmed Adam  Ruan de Jongh  Charles Mathye  Amit Satish Bhattu  Haroun Patel
Affiliation:1. Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa;2. Department of Paediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, Johannesburg, South Africa;3. The Division of Urology, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;4. Jupiter Hospital, Thane, (Formerly MPUH, Nadiad, Gujarat), India;5. Netcare Parklands, KZN, South Africa
Abstract:

Introduction

The ‘encrusted and forgotten double J ureteric stent (JJ) phenomenon has always proven to be a challenging dilemma facing the attending urologist.

Observation

Herein, we describe the first reported case of 3 encrusted stents within the same ureter, with an overall KUB score of 14 (K = 5, U = 4, B = 5). Complete (stent and stone) clearance was achieved using multiple combined, endo-urological procedures (sequentially) including; bladder stone laser lithotripsy, distal JJ stent coil resections, PCNL and prograde (flexible) ureteroscopy, followed by rigid and flexible retrograde ureteroscopy. The resulting reno-gram confirmed a 45% functioning ipsilateral system.

Conclusion

The first report of 3 encrusted stents within the same ureter is presented. The prevention of JJ stent encrustation is crucial via adequate and appropriate patient counselling. In most patients with forgotten encrusted stents who qualify for endoscopic management, a multi-modality approach is required.
Keywords:Forgotten stent  PCNL  Stent encrustation  Haematuria  Ureteroscopy  Double J stent (JJ stent)
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