ABSTRACT
A 63-year-old man presented with a 4-day history of right sided loin-to-groin pain. Computed tomography imaging revealed a 22 mm by 7 mm volume of contiguous ureteric calculi at the right vesicoureteric junction. Spontaneous steinstrasse was diagnosed with no recent history of extracorporeal shock wave lithotripsy (ESWL) or other urological intervention to the right kidney. Metabolic testing was negative. An initial plan was made for urgent primary ureteroscopy and lithotripsy, however, the patient spontaneously passed 20-25 calculi at home whilst awaiting his operation date. He was reviewed in clinic and his symptoms had resolved. His ureteroscopy was cancelled. This case represents an example of spontaneous steinstrasse with no identified causative factors, a rare occurrence on which little literature is available presenting a management dilemma to the treating clinician. The case described resolved prior to intervention prompting us to suggest that spontaneous steinstrasse can be initially managed conservatively, as in ESWL-associated steinstrasse.
Subject(s)
Acute Kidney Injury/complications , Anuria/complications , Ureteral Calculi/complications , Acute Kidney Injury/diagnosis , Acute Kidney Injury/diagnostic imaging , Adult , Anuria/diagnostic imaging , Humans , Male , Tomography, X-Ray Computed , Ureteral Calculi/diagnosis , Ureteral Calculi/diagnostic imagingABSTRACT
PURPOSE: Ureteral stenting plays a vital role in urology but still entails complications such as migration, encrustation, and blockage. We present our experience with a novel ureteral stent (Zebrastent) that had the complication of breakage which we explored by fatigue testing. MATERIALS AND METHODS: We developed a device that can reproduce the movements of the Zebrastent in vitro (bending and cranio-caudal movements). We estimated the number of movements of the stent during 1 day and we thus calculated how much stress would result if it were in place for 9 months. RESULTS: We estimate that the stent will not break when in place up to 9 months in a kidney with average curvature. However, the stent broke when it was used in a kidney with a sharper-than-normal curvature. CONCLUSIONS: The Zebrastent may be a valuable addition to the armamentarium of the endourologist, provided that the appropriate size is selected.
