A disastrous sequela of a missed ureteric stent

The Medical Journal of Australia ISSN: 0025729X 16 November 2009 191 10 567-568 ©The Medical Journal of Australia 2009 www.mja.com.au Lessons from Practice stents are well tolerated by most patients, stent-rela tions are frequent and a common cause of patients The most common side effects are irritative voidin suprapubic discomfort and haematuria, usually relate from the bladder coil, or flank pain related to urin micturition. Long-term stents, particularly those p management of ureteric strictures or compression no tent placement is one of the most common procedures performed in urological practice, as a stand-alone procedure to relieve renal obstruction, or as an adjunct to an increasing array of complex endourological procedures. Although urological ted complicare-presenting. g symptoms, d to irritation ary reflux on laced for the t amenable to reconstruction, are prone to encrustation, blocking and subsequent infection. The prospect of a “missed” stent is a constant source of anxiety to the practising urologist. Stents that have been inadvertently left in situ for many months act as niduses for stone formation, particularly at the proximal and distal coils, which may prevent easy stent removal. Encrustation increases stent fragility and may lead to its fragmentation, even during careful attempts at removal. Multiple procedures may be required to remove the stent completely. Encrustation may also impair urine drainage, resulting in unrecognised renal obstruction and silent kidney damage, necessitating nephrectomy. As in our patient, long-term obstruction may cause persistent infection and recurrent episodes of clinical pyelonephritis and subsequent pyonephrosis. From a biological viewpoint, it is not surprising that the combination of stent irritation and infection would lead eventually to malignant transformation, although to our knowledge this is the first reported case of ureteric carcinoma associated with a retained ureteric stent. Clinical record