Intracaval Migration of Ureteral Stent

Abstract

Ureteral stents have proven to be an invaluable tool for endourologists. Morbidity is minimal, but complications do exist. Up to 3 months complications are not frequent, but longer indwelling times are associated with increasing frequency of incrustation, infections, secondary stone formation, obstruction of the stented tract and migration.We report a rare case of a 33 year old pregnant patient with migration of an ureteral endoprosthesis. The patient received a right ureteral stent at 12 weeks for acute obstructive pyelonephritis. When her urologist tried to remove the ureteral stent post delivery, the stent was not found in the bladder. Ureteroscopy was performed but no ureteral stent was found. The patient showed a moderate improvement of the pyelonephritis, but complained about insidious palpitations.A CT scan was performed and showed the presence of the ureteral stent extending from the inferior vena cava up to the right atrium. Endovascular retrieval was performed through a puncture of the common femoral vein, using a curved guide that was introduced through the vena cava into the right atrium. Under fluoroscopic control, it was twisted around the stent and pulled out. The outcome was favorable, and no other complications were noted.

The mystery of the ureteric stent in the lumen of the terminal ileum

“…There is little in the literature about extraureteric stent migration, although cases have been reported with stent migration into the renal pelvis, inferior vena cava, inferior vena cava and extending into the right atrium 2 5. This is the first reported case of enteral migration of the stent.…”

“…The cystoscopic insertion of a ureteric stent is a minimally invasive procedure with low morbidity and high success rates,1 but is not exempt from complications. When ureteric stents are used for periods of up to 3 months, complications are infrequent, but longer indwelling times are associated with increased risks of incrustation, infections, secondary stone formation, obstruction of the stented tract and migration 2. Bladder overactivity symptoms caused by the lower end of the stent can occur in up to 80%–90% of patients leading to urgency, frequency, haematuria and dysuria 3.…”

“…It is believed that extraureteric stent migration is a result of a very fragile ureteric wall that could be due to chronic inflammation, ureteric wall trauma and even malignancy 2. The exact aetiology of benign ureteroenteric anastomotic strictures is unclear but they are most likely the result of periureteral fibrosis and scarring secondary to ischaemia or urine leakage at the anastomotic site 12.…”

Cystoscopic extraction of an inadvertently placed ureteral stent in inferior vena cava

“…A cause-specific mortality rate of 9% has been established based on reported cases of SIT [1] . Due to rarity of published reports of venous-ureteral fistulae, there are no data on the mortality rates of this condition [2] . Ureteral stenting is considered a safe procedure performed even when the clinical situation lacks scientific merit [3] .…”

“…Insertion of stents without fluoroscopy guidance, inadvertent insertion of the rigid reverse end of the guide wire and forcible stent insertion are the main operator-related risk factors [1] , [6] , [7] , [8] . However due to poor tissue quality, ureteric perforation may occur with minimal force [2] . Although X-ray KUB would suggest a malpositioned ureteral stent, the mainstay of diagnosis is by a CT KUB [1] .…”