錢祖明¹、呂硏嫚²、李經家¹、吳文正^1,3、*周以和¹

¹高雄醫學大學 附設中和紀念醫院 泌尿科

²高雄市立小港醫院 泌尿科

³高雄市立大同醫院 泌尿科

Tsu-Ming Chien¹、Yen-Man Lu²、Ching-Chia Li¹、Weng-Jeng Wu^{1, 3}、Yii-Her Chou¹

¹Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

²Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan

³Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

 

Retained iatrogenic foreign bodies are rare and preventable complications that may carry serious medical consequences. Due to the complexity of the endoscopic and minimal invasive procedures is increasing, the events of iatrogenic foreign bodies need to be carefully monitored.

 

We present a case with guidewire sheath within the renal pelvis. The patient had undergone percutaneous nephrostomy and extracorporeal shockwave lithotripsy in our institution two years before for renal urolithiasis. Computed tomography revealed a 15-cm-long thin hyper-dense object in the left renal pelvis. She was taken to the operating room for removal of a foreign body under general anesthesia. With the patient in the lithotomy position, a calcified guidewire sheath was found protruding from the lower renal pelvis with a semi-rigid ureterorenoscope. A flexible grasping forceps was secured to the protruding edge, and the guidewire sheath was removed piece by piece due to its fragility. Careful retrospective reanalysis of the kidney-ureter-bladder X-ray showed a hyperdense donut-shaped lesion at the left renal pelvis. The patient was discharged the next day without complications.

 

A comprehensive literature inquiry using the following database was used: Medline, Embase and Pubmed, dating from 1951 to 2017. Data was collected on 14 cases. Three cases (21.4%) were Nephrostomy tubes, 3 (21.4%) were Malecot nephrostomy, 3 (21.4%) were Intra-vascular tube , 2 (14.28%) were Nephrostomy threads, 1 was part of plastic drape, 1 was Amplatz sheath, and 1 was guidewire sheath.  

 

Although we rarely encounter foreign bodies in our institution, this is by bar one of the longest iatrogenic foreign bodies in the literature reports. This case highlights the need for careful diagnosis and prompt management in urologic practice.