Iatrogenic ureteral foreign bodies
A long-standing stent may fragment during removal, and instruments may break when working with dense stone; such objects must be removed before they become encrusted and cause obstruction. The ureteroscope is passed to the object under X-ray control, the fragment is grasped with a basket or forceps; the encrusted stent is previously released with a laser. If the object has gone into the pelvis, use a flexible ureterorenoscope. Once completed, a new stent is placed for 1-2 weeks. In difficult cases, access is performed percutaneously through the kidney.
Where do foreign bodies in the urinary tract come from?
Most often these are fragments of medical devices: fragments of catheters, stents, nephrostomies, ligatures and meshes after operations, migrated intrauterine devices; less often - objects inserted into the urethra by the patient himself, and fragments after injuries. A foreign body causes pain, blood in the urine, infection, and over time it becomes covered with salts and turns into stone, so it must be removed as soon as possible.
How to remove
Most foreign bodies are removed endoscopically: through a cystoscope, the object is grabbed with forceps, a basket or a loop and removed through the urethra; long and flexible objects are turned along their axis, inlaid objects are first freed from salts with a laser. Foreign bodies of the ureter are removed using a ureteroscope followed by stenting. For large, sharp or fixed objects where endoscopic removal risks damaging the urethra, a suprapubic approach is used. Antibiotic prophylaxis is mandatory.
