Stent-associated urolithiasis in children: A case reports

Abstract

In the treatment of children with urolithiasis, ureteral stents are used to relieve ureteral obstruction, often caused by stones migrating from the upper urinary tract. Stenting is an effective surgical procedure to use when conservative treatment has failed. However, a ureteral stent can cause side effects or complications, including salt encrustation. Few reports of such adverse effects of ureteral stents in pediatric urology prompted us to describe cases of stent-related complications, including migration, fragmentation, and incrustation. The aim of this paper is to present our experience in the treatment of stent-associated urolithiasis in children. Case description No. 1. A 16-year-old female patient was treated for complaints of persistent abdominal pain (above the pubic bone), increased urinary frequency, and dysuria. She has a history of ureteral stent removal (heavily encrusted with salts) 2 months ago; the stent was placed for renal colic associated with urolithiasis. A bladder stone was found during the examination. Urethrocystoscopy and contact laser lithotripsy were performed. The calculus was completely fragmented. The girl was discharged on day 5 after the surgery. Case description No. 2. A 16-year-old female patient was admitted to the Urology Department for routine staged treatment of urolithiasis including lithotripsy of stones in the right kidney, the upper third of the right ureter with a stent in the right kidney. She had a history of contact laser ureterolithotripsy 4 months ago (a calculus of the middle third of the right ureter was fragmented, a dendritic calculus of the right kidney was partially fragmented, and a ureteral stent was replaced. Flexible ureterorenoscopy and right-sided contact laser lithotripsy were required. Extensive incrustation of the distal stent was observed intraoperatively. Removal attempt failed (fixed in the proximal segment). Ureteral exploration in the pyelourethral segment revealed calculus in the proximal segment of the stent. During contact lithotripsy of a calculus on a stent, a ureteral catheter fractured. A flexible ureterorenoscope and laser lithotripter were used for stone fragmentation in the right kidney. The proximal segment of the stent could not be removed due to the high risk of ureteral injury. After a medical pause (after 4 weeks), a repeat flexible ureterorenoscopy, right-sided contact laser lithotripsy and right-sided foreign body removal (stent site) were performed. The girl was discharged in satisfactory condition on day 3 after surgery. A review of the medical literature revealed a lack of guidelines for successfully managing these potentially serious conditions. Two clinical cases with similar complications and ways to solve them were found and described in foreign sources.

Keywords

urolithiasis / ureteral stent / stenting complications / stent migration / fragmentation / encrustation / children / case series

References

[1] Lopatkin NA. Urology: national guidelines. Brief edition. Moscow: GEOTAR-media, 2013. 608 p. (In Russ.)

[2] Лопаткин Н.А. Урология: Национальное руководство. Краткое издание / под ред. Н.А. Лопаткина. Москва: ГЭОТАР-Медиа, 2013. 608 с.

[3] Lopatkin NA. Urology: national guidelines. Brief edition. Moscow: GEOTAR-media, 2013. 608 p. (In Russ.)

[4] Razumovsky AYu, editor. Pediatric surgery: anational guide. 2nd ed. Moscow: GEOTAR-Media, 2021. 1280 p. (In Russ.)

[5] Детская хирургия: национальное руководство / под ред. А.Ю. Разумовского. 2-е изд., перераб. и доп. Москва: ГЭОТАР-Медиа, 2021. 1280 с.

[6] Razumovsky AYu, editor. Pediatric surgery: anational guide. 2nd ed. Moscow: GEOTAR-Media, 2021. 1280 p. (In Russ.)

[7] Ahallal Y, Khallouk A, El Fassi MJ, Farih MH. Risk factor analysis and management of ureteral double-J stent complications. Rev Urol. 2010;12(2-3):147–151.

[8] Ahallal Y., Khallouk A., El Fassi M.J., Farih M.H. Risk factor analysis and management of ureteral double-J stent complications // Rev Urol. 2010. Vol. 12, N 2-3. P. 147–151.

[9] Ahallal Y, Khallouk A, El Fassi MJ, Farih MH. Risk factor analysis and management of ureteral double-J stent complications. Rev Urol. 2010;12(2-3):147–151.

[10] Venkatesan N, Shroff S, Jeyachandran K, Doble M. Effect of uropathogens on in vitro encrustation of polyurethane double J ureteral stents. Urol Res. 2011;39(1):29–37. doi: 10.1007/s00240-010-0280-7

[11] Venkatesan N., Shroff S., Jeyachandran K., Doble M. Effect of uropathogens on in vitro encrustation of polyurethane double J ureteral stents // Urol Res. 2011. Vol. 39, N 1. P. 29–37. doi: 10.1007/s00240-010-0280-7

[12] Venkatesan N, Shroff S, Jeyachandran K, Doble M. Effect of uropathogens on in vitro encrustation of polyurethane double J ureteral stents. Urol Res. 2011;39(1):29–37. doi: 10.1007/s00240-010-0280-7

[13] Kogan MI, Shkodkin SV, Lyubushkin AV, Miroshnichenko OV. Directions and perspectives of the urological stent development (literature review). Experimental and clinical urology. 2014;(4):64–71. EDN: TYRNXN

[14] Коган М.И., Шводкин С.В., Любушкин А.В., Мирошниченко О.В. Направления и перспективы в разработке урологических стентов (обзор литературы) // Экспериментальная и клиническая урология. 2014. № 4. С. 64–71. EDN: TYRNXN

[15] Kogan MI, Shkodkin SV, Lyubushkin AV, Miroshnichenko OV. Directions and perspectives of the urological stent development (literature review). Experimental and clinical urology. 2014;(4):64–71. EDN: TYRNXN

[16] Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967;97(5):840–844. doi: 10.1016/S0022-5347(17)63130-6

[17] Zimskind P.D., Fetter T.R., Wilkerson J.L. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically // J Urol. 1967. Vol. 97, N 5. P. 840–844. doi: 10.1016/S0022-5347(17)63130-6

[18] Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967;97(5):840–844. doi: 10.1016/S0022-5347(17)63130-6

[19] Tsukanov AYu, Akhmetov DS, Novikov AA, et al. Prevention of encrustation and biofilm formation ureteral stent surface. Part 1. Experimental and clinical urology. 2020;(3):176–181. EDN: MGLZSD doi: 10.29188/2222-8543-2020-12-3-176-181

[20] Цуканов А.Ю., Ахметов Д.С., Новиков А.А., и др. Профилактика инкрустации и образования биопленок на поверхности мочеточникового стента. Часть 1 // Экспериментальная и клиническая урология. 2020. № 3. С. 176–181. EDN: MGLZSD doi: 10.29188/2222-8543-2020-12-3-176-181

[21] Tsukanov AYu, Akhmetov DS, Novikov AA, et al. Prevention of encrustation and biofilm formation ureteral stent surface. Part 1. Experimental and clinical urology. 2020;(3):176–181. EDN: MGLZSD doi: 10.29188/2222-8543-2020-12-3-176-181

[22] Tomer N, Garden E, Small A, Palese M. Ureteral stent encrustation: epidemiology, pathophysiology, management and current technology. J Urol. 2021;205(1):68–77. doi: 10.1097/JU.0000000000001343

[23] Tomer N., Garden E., Small A., Palese M. Ureteral stent encrustation: epidemiology, pathophysiology, management and current technology // J Urol. 2021. Vol. 205, N 1. P. 68–77. doi: 10.1097/JU.0000000000001343

[24] Tomer N, Garden E, Small A, Palese M. Ureteral stent encrustation: epidemiology, pathophysiology, management and current technology. J Urol. 2021;205(1):68–77. doi: 10.1097/JU.0000000000001343

[25] Martov AG, Popov SV, Obidnyak VM, et al. Design and materials for ureteral stents: past, present and future. Urologiia. 2020;(2):85–93. EDN: XIAYXM doi: 10.18565/urology.2020.1.85-92

[26] Мартов А.Г., Попов С.В., Обидняк В.М., и др. Дизайн и материалы мочеточниковых стентов: прошлое, настоящее и будущее // Урология. 2020. № 2. С. 85–93. EDN: XIAYXM doi: 10.18565/urology.2020.1.85-92

[27] Martov AG, Popov SV, Obidnyak VM, et al. Design and materials for ureteral stents: past, present and future. Urologiia. 2020;(2):85–93. EDN: XIAYXM doi: 10.18565/urology.2020.1.85-92

[28] Mosayyebi A, Manes C, Carugo D, Somani BK. Advances in ureteral stent design and materials. Curr Urol Rep. 2018;19(5):35. doi: 10.1007/s11934-018-0779-y

[29] Mosayyebi A., Manes C., Carugo D., Somani B.K. Advances in ureteral stent design and materials // Curr Urol Rep. 2018. Vol. 19, N 5. ID 35. doi: 10.1007/s11934-018-0779-y

[30] Mosayyebi A, Manes C, Carugo D, Somani BK. Advances in ureteral stent design and materials. Curr Urol Rep. 2018;19(5):35. doi: 10.1007/s11934-018-0779-y

[31] Barghouthy Y, Wiseman O, Ventimiglia E, et al. Silicone-hydrocoated ureteral stents encrustation and biofilm formation after 3-week dwell time: results of a prospective randomized multicenter clinical study. J Urol. 2021;39(9):3623–3629. doi: 10.1007/s00345-021-03646-0

[32] Barghouthy Y., Wiseman O., Ventimiglia E., et al. Silicone-hydrocoated ureteral stents encrustation and biofilm formation after 3-week dwell time: results of a prospective randomized multicenter clinical study // J Urol. 2021. Vol. 39, N 9. P. 3623–3629. doi: 10.1007/s00345-021-03646-0

[33] Barghouthy Y, Wiseman O, Ventimiglia E, et al. Silicone-hydrocoated ureteral stents encrustation and biofilm formation after 3-week dwell time: results of a prospective randomized multicenter clinical study. J Urol. 2021;39(9):3623–3629. doi: 10.1007/s00345-021-03646-0

[34] Ye Z, Mi Q, Huang R. Stent encrustation or fragmentation? A case report of post stent removal encrustation in postpartum woman and literature review. BMC Pregnancy Childbirth. 2021;21(1):789. doi: 10.1186/s12884-021-04262-x

[35] Ye Z., Mi Q., Huang R. Stent encrustation or fragmentation? A case report of post stent removal encrustation in postpartum woman and literature review // BMC Pregnancy Childbirth. 2021. Vol. 21, N 1. ID 789. doi: 10.1186/s12884-021-04262-x

[36] Ye Z, Mi Q, Huang R. Stent encrustation or fragmentation? A case report of post stent removal encrustation in postpartum woman and literature review. BMC Pregnancy Childbirth. 2021;21(1):789. doi: 10.1186/s12884-021-04262-x

RIGHTS & PERMISSIONS

Eco-Vector