Two Forgotten Ipsilateral Double J Stents Managed in a Single Session: A Rare Endourologic Challenge

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Forgotten ureteral stents, especially beyond 12 weeks, pose risks of encrustation, infection, obstruction, and stone formation.
• Management of dual forgotten Double J (DJ) stents within the same renal system in a single session is uncommon.
• Incidental discovery of asymptomatic, encrusted, dual forgotten DJ stents necessitates effective treatment strategies.

Purpose of the Study:

• To report a rare case of dual forgotten DJ stents with severe encrustation and stone formation.
• To evaluate the safety and efficacy of a single-session tri-modality endourological approach for managing complex forgotten stents.
• To highlight the successful treatment of severe dual-stent encrustation using coordinated multimodality endourology.

Main Methods:

• A 51-year-old male with incidentally found, asymptomatic, dual forgotten left DJ stents (placed 2021 and 2024) underwent CT imaging.
• CT revealed encrustation with multiple renal and ureteric stones, while renal function remained preserved.
• A single-session tri-modality approach combining cystolithotripsy, ureteroscopic lithotripsy, and lower-pole percutaneous nephrolithotomy was employed for stent removal.

Main Results:

• Complete removal of both encrusted dual forgotten DJ stents was achieved in a single operative session.
• The tri-modality approach successfully managed the associated encrustation and multiple renal and ureteric stones.
• Post-procedure, a new stent was placed, with a planned second-stage check via retrograde intrarenal surgery (RIRS).

Conclusions:

• Severe dual-stent encrustation and associated lithiasis can be safely and effectively treated with a coordinated multimodality endourological strategy.
• Single-session management of complex forgotten ureteral stents is feasible and preserves renal function.
• This case underscores the importance of timely ureteral stent removal to prevent severe complications.