A Rare Case of Forgotten DJ Stent for 15 Years – Timely Intervention That Saved a Kidney

By Dr. G R Manjunath, Consultant Urologist, Bengaluru

Introduction: A Hidden Danger Many Forget

In urology practice, Double J (DJ) stents are life-saving devices used to drain urine from the kidney to the bladder after a procedure such as ureteroscopy or stone removal. However, what most patients don’t realize is that these stents are temporary and must be removed within a fixed period—usually between 2 weeks to 1 month.

If left forgotten, a DJ stent can silently turn into a dangerous source of infection, stone formation, and even kidney damage. Recently, I encountered one such rare and eye-opening case that reminds us how crucial regular follow-up is after any urological procedure.

Case Presentation: A 70-Year-Old With Persistent Pain and Fever

A 70-year-old male patient presented to my clinic, with complaints of left-sided flank pain, fever, and burning urination that had persisted on and off for several weeks.

On initial evaluation, his symptoms pointed toward a possible urinary tract infection or obstruction. But his medical history revealed a shocking detail — a DJ stent had been placed almost 15 years ago following a ureteroscopic procedure . The stent had passed out through urethra spontaneously after few days of surgery and the patient did not follow up further with the operating surgeon.

Clinical Findings and Diagnostic Evaluation

The patient was evaluated thoroughly. Laboratory results showed evidence of infection and acute kidney injury (AKI) with creatinine 1.8 mg/dL, in the background of diabetes mellitus (DM).

A urine culture confirmed infection, and imaging studies were performed to assess the condition of the urinary tract. The stent had calcified fragments, and stones had formed around it—one in the bladder and another in the kidney.

To evaluate kidney function, a DTPA Renogram was performed, which fortunately showed both kidneys functioning well, though the left kidney was mildly compromised due to infection and obstruction.

Initial Management: Stabilizing the Patient

The first step was to stabilize the patient. Since he was septic, he was admitted and treated with intravenous (IV) antibiotics to control infection and inflammation. Adequate hydration and close monitoring of kidney function were ensured. Over the next few days, the patient’s condition improved, and his kidney parameters normalized.

Once clinically stable, we planned definitive surgical management to remove the encrusted stent and stones.

Surgical Intervention: Single stage procedure

Given the complexity of the case, I chose a combined, staged surgical plan involving Cystolithotripsy, Left PCNL (Percutaneous Nephrolithotomy), and DJ Stent Replacement.

1. Cystolithotripsy – Using endoscopic laser technology, the bladder stone that had formed around the lower end of the old stent was fragmented and removed.

   
   

2. PCNL (Left) – Through a small incision in the flank, the kidney stones and the calcified upper stent portion were cleared using advanced minimally invasive techniques.

   
   

3. DJ Stent Reinsertion – A new stent was placed temporarily to ensure smooth drainage during the recovery phase.

   
   

The surgery was completed successfully without complications, and the patient was discharged on post-operative day 2, with stable vitals and good urine output.

Follow-Up and Recovery

The patient recovered well at home. After 15 days, the newly placed stent was safely removed. A follow-up renal function test and ultrasound confirmed normal kidney function and complete clearance of stones.

It was truly gratifying to see that despite 15 years of neglect, the kidney had retained its function—a rare occurrence, as most forgotten DJ stents cause irreversible kidney damage or loss.