Urologic Stenting-induced Trauma: A Comprehensive Review and Case Series

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

“…During removal, stents may cause undue damage to the ureter like ureteric avulsion and urine extravasation. Such injuries are categorized together under stenting induced trauma (SIT) [1] . Inadvertent entry of the stent into adjacent major vessels after perforation of the ureter is an important form of SIT due to its potential of causing life threatening complications.…”

“…It is defined as traumatic injuries incurring to the urinary tract during the insertion and removal of ureteric stents. Major vessels are commonly involved apart from the gastro intestinal system [1] . According to published case reports, malposition of ureteral stents into adjacent major arteries is commoner than veins.…”

“…According to published case reports, malposition of ureteral stents into adjacent major arteries is commoner than veins. 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] .…”

“…Patient related risk factors for SIT are pelvic irradiation, pelvic malignancy, extirpative pelvic surgery, urolithiasis, urinary diversion and vascular pathologies. 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] .…”

“…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] . Removal of such stents can be attempted endoscopically, percutaneously or by open surgery [1] .…”