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Complications after renal allograft transplantation are not so uncommon. Most complications are related to graft rejection, immune-suppressive drug toxicity and the operative procedure. Stents are placed after a transplant to prevent urine leak at the site of ureteric reimplantation, to facilitate an early healing in immune-suppressed individuals and to prevent obstruction at the site of ureteral anastomosis. We report a case of a renal allograft recipient with a forgotten ureteral double J stent. where the stent remained in situ for more than 4 years and further complicated by encrustation and stone formation at both the bladder and renal pelvic ends. The stone over the bladder coil was removed by holmium laser cystolithotripsy while the encrusted renal pelvic coil was removed by percutaneous approach. This case is presented for its rarity and also to emphasise on the need for maintenance of a stent register in order to ensure avoidance of such preventable complications.

Urologists rely heavily on indwelling ureteral stents to manage urinary tract obstruction secondary to calculi, malignancy, stricture, congenital anomalies, or edematous response to operative procedures (Borboroglu and Kane, 2000). The use of a ureteral stent is a temporary intervention and requires removal to prevent potential complications. However, patient noncompliance with follow-up may lead to encrustation of the ureteral stent. Given the widespread use of indwelling ureteral stents in urologic practice, the issue of encrustation secondary to a retained stent is a significant clinical challenge.

A 70-year-old man was referred to our clinic for removal of a retained encrusted pigtail ureteral stent. Previously, in another institution they tried to remove the stent but it was broken and the intravenous pyelography(IVP) showed that the piece of the stent was located in the left renal pelvis. The retained stent was tried to be removed by rigid ureteroscopy (as the flexible was damaged at that occasion) but we were unsuccessful. Before attempting a more invasive procedure we tried extra corporal shock wave lithotripsy, (ESWL) to fragment the encrusted double-J and enable the patient to pass fragments from the ureter. After two sessions the stent was completely disintegrated and the patient passed all of the fragments easily to become stent-free after 2 months.

We describe the application of a new two-stage endoscopic procedure for removal of a retained stent in the common bile duct (Type 1 foreign body in Ban's classification). The technique involves sphincterotomy and placement of the endoprosthesis.

Original article can be found at : http://www.nature.com/ Copyright Nature Publishing Group [Full text of this article is not available in the UHRA]