A Rare 5-Year Forgotten DJ Stent Case: Timely Intervention Saved a Patient from Life-Threatening Complications

Authored by Dr. G R Manjunath, Senior Consultant Urologist , Best Urologist in Bangalore

Introduction: When a Small Neglect Becomes a Major Health Risk

As a urologist, I often meet patients who underestimate the importance of follow-up care after urological procedures. One of the most concerning situations is the “forgotten DJ stent”, a complication that can silently progress into severe infections, kidney damage, and life-altering consequences.

This case study discusses a 73-year-old gentleman who came to me with a retained right DJ stent that had remained inside his body for over 5 years—a rare yet critical scenario. What made his case even more complex was the presence of a large bladder stone, multiple kidney stones, sepsis, and ultimately, a non-functional kidney.

Case Background: When the Past Catches Up

The patient had undergone Right PCNL (Percutaneous Nephrolithotomy) in a neighboring country 5 years ago. As part of the standard procedure, a DJ stent was placed to ensure proper drainage of urine and to allow the ureter to heal. Unfortunately, the stent was never removed.

He presented to the Hospital with the following symptoms:

• High-grade fever

• Dysuria (painful urination)

• Burning sensation while passing urine

• Poor urinary flow

  
  

Despite the serious symptoms, his renal function was surprisingly normal, which gave us some room to stabilize him before planning surgery.

Initial Evaluation and Diagnosis

On examination and investigation, the following major findings were noted:

1. Sepsis

He was in an active state of infection—dangerously high risk, considering his age.

2. Retained Right DJ Stent

The stent had calcified along most of its length and acted as a nucleus for stone formation.

3. Large Bladder Stone

A significant bladder stone was found, formed over the lower coil of the forgotten stent.

4. Shrunken Right Kidney with Multiple Calculi

The upper coil of the stent had led to chronic inflammation, resulting in multiple large kidney stones and a shrunken kidney.

5. Poorly Functioning Right Kidney

A DMSA Renogram revealed that the right kidney had minimal function, indicating irreversible damage.

🩺 The Step-By-Step Treatment Plan

Due to the complexity of the case, careful staging was crucial.

Step 1: Stabilisation with IV Antibiotics

Before any surgical intervention, the priority was to control sepsis.We provided:

• Broad-spectrum IV antibiotics

• Hydration

• Close monitoring

Once his infection markers reduced, we planned the next stage.

Step 2: Diagnostic Cystoscopy

A cystoscopy was performed to assess the bladder and lower end of the stent. The findings confirmed:

• A heavily encrusted stent

• A large bladder calculus

• Inflamed bladder mucosa

Due to the size of the stone and the infection, endoscopic removal was not safe.

Step 3: Open Cystolithotomy

Considering the stone size and patient safety, I decided to perform an open cystolithotomy.

This allowed:

• Complete removal of the bladder stone

• Better access to the calcified stent

• Prevention of urethral injury

The patient recovered well post-operation.

Step 4: Interval Period for Healing

We allowed a 4-week recovery period, keeping the infection under control and ensuring the bladder healed completely.

Step 5: Laparoscopic Nephrectomy & DJ Stent Removal

The final and most critical step involved:

• Right laparoscopic nephrectomy (removal of the non-functioning kidney)

• Complete removal of the DJ stent in one piece (“in toto”)

The surgery was minimally invasive, and the patient tolerated it remarkably well.

🩹 Recovery and Follow-up

The gentleman recovered smoothly after the nephrectomy. Since the remaining kidney was healthy and functioning well, he adapted without difficulty.

It has now been two years since the surgery, and he continues to live a normal, active life without any urinary symptoms.

💡 Take-Home Message: DJ Stents Must NOT Be Ignored

A DJ stent is a temporary device—not meant to stay inside beyond 4–6 weeks in most cases.

Failing to remove it can lead to:

• Severe infections

• Stone formation

• Kidney damage

• Bladder issues

• Life-threatening sepsis

  
  

This case is a strong reminder that timely follow-up and stent removal are as important as the procedure itself.

If you have ever undergone PCNL, URS, or any ureteric procedure, ensure your stent removal is scheduled and documented.