1. Dr B.Aravind Reddy 2nd yearNephrology Resident Gandhi Hospital
Case Snippet
Dr B.Aravind Reddy
2nd yearNephrology Resident
Gandhi Hospital

2. Case Report… 45 Yr old Male Mr.X ,non DM, nonHTN
C/o Loin pain, dysuria for 15 days.
Oligoanuria for 3 days
Azotemia for 3 days.
H/s/o LUTS
H/o Gravelluria.
H/o Urology surgery – 10 years back at karimnagar(details not available),lost follow up there after.
At admission : general and systemic examination : unremarkable

3. Investigations… Hb-10.3gm/L TLC-16800 PLT-2.3L LFT-WNL S.Creat 18mg/dl
CUE Alb-nil
RBC-nil
Pus cells plenty
Urine C/S sterile
USG abdomen: Right kidney normal.Left gross HDUN, hyperechoic content noted in the bladder with posterior shadow extending upto ureteral opening : suggestive of calcified DJ stent

4. Imaging…X ray KUB
Migration
Encrustation
Fragmentation
Stone formation

5. CT plain KUB:
30mm calculus in urinary bladder with calcified DJ stent traceable upto distal ureter.

6. Diagnosis and management
Forgotten DJ stent with complications
Left gross hydroureteronephrosis with Vesical calculus with urosepsis – AKI(AKIN3)recovered.
Initiated on HD through Right IJV .
Left PCN done
Ursl +Left DJS removal followed by Open cystolithotomy.
Serum creatinine was 2mg/dl and is dialysis independent.

8. Ideal ureteral stent… Easily inserted from any access
Resistant to migration
Optimal flow characteristics
Well tolerated by patient
Biocompatible
Biodurable
Resistant to encrustation
Nonrefluxing
Radiopaque or visible at US
Easily exchanged and removed
Affordable

10. Review of Literature…

12. Take home message… Adequate counseling before putting DJ stent.
Stringent and regular follow up of those with stent.

13. THANK YOU