The Forgotten Indwelling Ureteral Stent: A Urological Dilemma

Ureteral stents are an integral part of urological practice. However, stents that migrate, fragment or are forgotten pose a management and legal dilemma. Our series consists of 31 patients, 22 with forgotten stents that were left indwelling for more than 6 months (mean 22.7) and 9 migrated stents. Of the forgotten stents 15 (68 percent) were calcified, 10 (45 percent) were fragmented, and 3 (14 percent) were calcified and fragmented. Procedures to render the patient stent-free were ureteroscopy in 16 (52 percent), percutaneous nephroscopy in 8 (26 percent), cystoscopic electrohydraulic lithotripsy in 6 (19 percent), extracorporeal shock wave lithotripsy in 10 (32 percent), open cysto-litholapaxy in 1 (3 percent) and simple nephrectomy in 1 (3 percent). Multiple procedures were required in 6 patients (19 percent). Management of such complicated ureteral stents requires a multimodal therapeutic approach incorporating the latest in extracorporeal shock wave lithotripsy and endourological techniques. These patients are at increased risk for loss of renal function. A computerized tracking registry of ureteral stents may help prevent this urological travesty.