Ureteral catheterization is a procedure done to allow for renal drainage. Since first used in 1893 for urine sampling, benefits increased to include facilitation of ureteral healing and maintaining a patent ureter. Complications arise from ureteral stents especially when they are forgotten. We present our management of a case of neglected stent.

A 44-year-old male consulted at our institution due to fever and passage of stent fragments. He had undergone ureteroscopy, stone basked extraction, laser lithotripsy, and DJ stent insertion for a ureterolithiasis 24 months prior and was lost to follow up. CT scan showed an encrusted proximal portion of DJ stent, tubular structures 3.8cm and 1.2cm in length at the distal ureter, and a coiled structure in the urinary bladder. The patient was placed under general anesthesia and in Galdakao-modified Valdivia position. On cystoscopy, a fragmented distal portion of DJ stent was seen in the bladder and extracted using a grasper. Fr7.5 ureteroscope inserted and lithiasis was seen at the distal ureter, fragmented and dusted using Magneto Cyber150 holmium laser 10W. Stent fragments were encountered at the distal ureter which were extracted. An open-end ureteral catheter was advanced up to the renal pelvis and RGP was done. Supine percutaneous access was made below the 12th rib and into the inferior pole calyx and dilated up to 27Fr. 24Fr Karl Storz nephroscope. Lithiasis was fragmented using pneumatic lithotripsy and extracted with grasper. A stent fragment was seen embedded into the urothelium of the renal pelvis and extracted. Upon stone clearance, a 6Frx24cm DJ stent, nephrostomy tube 18Fr clamped, and 2-way 18Fr IFC were inserted.

The patient had no dysuria, flank pain, and fever. Nephrostomy tube was removed 2 days postop, IFC at 3 days postop, and DJ stent at 2 weeks postop.

Neglected stents can cause significant complications and require complex management. Patient education and adherence to follow up must be emphasized.