Endoscopic Removal of Foreign Body Within the Ureter

Abstract

Introduction:

Migration of surgical clips is a well-known phenomenon that is not uncommon. Migration of clips into the ureter is a rarely described event with only few case reports described in the literature. ^{1 –5} This is a case of a 60-year-old female with a history of multiple abdominal surgeries who presented for vague abdominal discomfort. She was found to have an encrusted surgical clip embedded within the wall of the mid/distal ureter.

Materials and Methods:

Ureteroscopy and holmium laser lithotripsy with basket extraction were performed for elimination of encrustation. The surgical clip was embedded within the wall of the ureter and was unable to be removed in its entirety with basket extraction. A small endoureterotomy was performed and fragmentation of the base of the surgical clip was done using the holmium laser. The endoureterotomy was performed using laser settings of 1 J and 10 Hz, whereas lasering of the clip was performed using 1 J and 5 Hz. The clip pieces were subsequently extracted and a stent was placed.

Results:

A small portion of the surgical clip remained embedded in the side wall and was unable to be extracted. The goal was for the ureteral wall to heal with the remaining fragments outside the lumen. Unfortunately, the patient was lost to follow-up after the first postoperative visit.

Conclusion:

Erosion of a surgical clip into the ureter is rarely described and can be complicated by encrustation leading to obstruction. ^3,4 Endoscopic removal of the entire surgical clip has been reported in the literature but it may not always be possible. ^3,4,6 Careful partial removal of embedded clips can be performed safely but long-term outcomes are unknown.

No competing financial interests exist.

Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

Runtime of video: 5 mins 16 secs

Video presentation: Setia S, Deane L. Endoscopic removal of foreign body within the ureter. Annual Meeting of World Congress of Endourology, Abu Dhabi, UAE, October 2019.