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 l egal dilemma. Our series consists of 31 patients, 22 with forgotten st ents that were left indwelling for more than 6 months (mean 22.7) and 9 migrated stents. Of the forgotten stents 15 (68%) were calcified, 10 (45%) were fragmented, and 3 (14%) were calcified and fragmented. Pro cedures to render the patient stent-free were ureteroscopy in 16 (52%) , percutaneous nephroscopy in 8 (26%), cystoscopic electrohydraulic li thotripsy in 6 (19%), extracorporeal shock wave lithotripsy in 10 (32% ), open cysto-litholapaxy in 1 (3%) and simple nephrectomy in 1 (3%). Multiple procedures were required in 6 patients (19%). Management of s uch complicated ureteral stents requires a multimodal therapeutic appr oach incorporating the latest in extracorporeal shock wave lithotripsy and endourological techniques. These patients are at increased risk f or loss of renal function. A computerized tracking registry of uretera l stents may help prevent this urological travesty.