Antegrade percutaneous retrieval of a retained metallic ureteral stent embedded in subcutaneous tissue: A practical fluoroscopy-guided approach

Metallic ureteral stents provide excellent resistance to extrinsic compression, allowing for prolonged indwelling times; however, their extraction can be complicated by tissue ingrowth and mechanical failure. We report a complex case of a 33-year-old male with a history of bladder exstrophy, a Mitrofanoff appendicovesicostomy, and chronic kidney disease who underwent an antegrade percutaneous exchange of a right 6Fr metallic ureteral stent. During extraction, a sub-optimal grasp along the stent's shaft caused the rigid device to fold over itself and become wedged within the 8Fr working sheath, severely bending the stent. After the sheath was withdrawn, the proximal portion of the stent became embedded extra-renally within the subcutaneous fat. Standard endourological graspers lacked sufficient mechanical strength for extraction. A practical soft-tissue foreign body retrieval technique was employed under continuous real-time fluoroscopy, utilizing a robust curved artery forceps to successfully grasp and extract the metallic stent completely. This case underscores the technical challenges associated with the unique design of metallic stents, the importance of accurate proximal tip grasping, the necessity of appropriately sized working sheaths, and the utility of real-time fluoroscopy in managing retained percutaneous foreign bodies.