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Case profile: Double-j catheter encrustation
CASE PROFILE: DOUBLE-J CATHETER ENCRUSTATION* pi&ii-j A fifty-nine-year-old Hawaiian male with longstanding urinary tract stone disease (right ureterolithotomy in 1969, left nephrolithotomy in 1970, right ureterolithotomy in 1983, several spontaneously passed stones, and approximately 10 basket extractions of distal ureteral calculi) presented with a right renal pelvic stone, symptomatic with fever in 1983. For this problem the patient underwent right pyelolithotomy in October, 1983, which was complicated by persistent right flank drainage. A DOUBLE-J ureteral stent was inserted endoscopically without difficulty on October 28, 1983. The flank drainage stopped. A retrograde cystogram and excretory urogram one month after placement of the stent were unremarkable. The patient did not keep any appointments in the Urology Clinic until he presented in July, 1984, with left renal colic, at which time he was found to have small calculi in the distal ureter with partial obstruction and two 1.5cm stones within the collecting system of the left kidney. At that time, the DOUBLE-J stent was
FIGURE 2. Ureteral stent after surgical Te-
mow al.
noted to be completely encrusted with calcium deposits (Fig. 1). It was apparent that the stent could not be removed through either the bladder or through the renal pelvis alone, owing to the magnitude of the calcium formations. Because we anticipated significant damage of the right ureter, exploration was performed transabdominally and transperitoneally. Indeed, the right ureter was virtually destroyed. We elected, therefore, to remove the stones in the left kidney and to reconstruct the urinary tract using a left-to-right pyeloileo-pyelovesicostomy, after removal of the stent and ureteral fragments (Fig. 2). His postoperative course was uneventful, and he continues to be well. Capt.
FIGURE 1.
Encrusted DOUBLE-I plain radiograph.
436
ureteral stent,
Jill A. Antoine, (MC) USA (Reprints) Col. Douglas W. Soderdahl, (MC) USA Tripler Army Medical Center Honolulu, Hawaii 96859-5000
*The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army or Defense.
UROLOGY
/ NOVEMBER 1986 / VOLUME XXVIII, NUMBER 5
FIGURE 2. Ureteral stent after surgical Te-
mow al.
noted to be completely encrusted with calcium deposits (Fig. 1). It was apparent that the stent could not be removed through either the bladder or through the renal pelvis alone, owing to the magnitude of the calcium formations. Because we anticipated significant damage of the right ureter, exploration was performed transabdominally and transperitoneally. Indeed, the right ureter was virtually destroyed. We elected, therefore, to remove the stones in the left kidney and to reconstruct the urinary tract using a left-to-right pyeloileo-pyelovesicostomy, after removal of the stent and ureteral fragments (Fig. 2). His postoperative course was uneventful, and he continues to be well. Capt.
FIGURE 1.
Encrusted DOUBLE-I plain radiograph.
436
ureteral stent,
Jill A. Antoine, (MC) USA (Reprints) Col. Douglas W. Soderdahl, (MC) USA Tripler Army Medical Center Honolulu, Hawaii 96859-5000
*The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army or Defense.
UROLOGY
/ NOVEMBER 1986 / VOLUME XXVIII, NUMBER 5