Displacement of a Ureteral Single J Stent into the Heart: A Case Report and Literature Review

Abstract

The placement of urethral stents is a commonly performed procedure in urology, typically without complications. However, as illustrated in the present case, major complications can arise. It is crucial to be vigilant about the risk of intravascular or intracardiac malpositioning of the ureteral device, especially when there is an unfavorable evolution or the presence of hematuria. We present the case of a 68-year-old patient undergoing treatment for locally advanced cervical cancer with concomitant radiotherapy and chemotherapy. In the course of her follow-up, the patient developed obstructive renal failure due to extrinsic compression of the ureters. Despite attempts with JJ stent placement, emergency renal drainage became necessary, leading to bilateral nephrostomy. In order to alleviate the patient from nephrostomy tubes and enhance her quality of life, bilateral direct cutaneous ureterostomy was performed, with Single-J probes placed in both ureters. However, during the 4th tube change, conducted without scopic control, the patient experienced thoracic and low back pain at 8 days post-operatively. The CT scan revealed that the left Single-J probe bypassed the renal pelvis without penetrating it. Instead, it ascended the IVC, entering the right atrium, and subsequently reached the right ventricle, accompanied by left pyelocaliectasis. The resolution of the issue was achieved through the implementation of a multidisciplinary approach, engaging the expertise of both urologists and vascular surgeons. The removal procedure involved extracting the distal end of the catheter using a ureteroscope, with simultaneous collaboration from the vascular surgery team. The vascular surgeons performed femoral access and phlebography both during and after catheter removal to mitigate the risk of potential bleeding from the inferior vena cava (IVC). Abdominal access for laparotomy was prepared in anticipation of potential bleeding." The patient underwent placement of a left Single-