Renal Parenchymal Damage and Persistent Hematuria after D-J Insertion: A Report on Two Cases

In this case series, we present two male cases with renal parenchymal perforation without perirenal hematoma after D-J ureteral stent insertion, one with nutcracker renal vein syndrome. Our study provides new and important contributions to the field of science regarding what to consider during D-J stent insertion in similar cases and in patients with obstruction in the urinary collecting system for more than 2 months.

Two patients, 30 and 37 years old, who were inserted a D-J catheter after endoscopic ureteral stone treatment, suffered from severe ipsilateral flank pain and hematuria after the operation. The Kidney Urine Bladder (KUB) radiography showed that the proximal part of the D-J stent was protruding from the upper calyx and parenchyma of the kidney in both patients. One of the patients had an ipsilateral nutcracker renal vein syndrome, and the clinical progression was more severe. In both cases, conventional follow-up with bed rest, nonsteroidal anti-inflammatory (NSAI) therapy, intravenous (IV) fluid infusion, and anti-biotherapy after the D-J stent reposition was sufficient. The patients had no clinical problems during the next outpatient clinic visits.

Double-j (D-J) ureteral stent insertion procedure may cause many life-threatening complications, from subcapsular hematoma to pulmonary embolism. In this case series, conventional follow-up was sufficient for the treatment of patients with renal parenchymal damage without perirenal hematoma due to D-J stent insertion, including nutcracker renal vein syndrome cases. More care should be taken when placing D-J stents, especially in patients with obstruction in the urinary collecting system for more than 2 months and with nutcracker renal vein syndrome. In these patients, the soft proximal end of the guidewire should not be pushed and forced too hard to the upper part of the kidney and upper collecting system. Additionally, the D-J stent placement procedure should be performed under fluoroscopy as much as possible to avoid complications.