Contralateral Hydronephrosis - An Overlooked Post-Stent Complication: A Case Report

Background: Nephrolithotripsy is the second most common procedure to remove kidney stones in the United States. While injury after stent placement is verified with irrigation and cystoscopy, secondary complications can arise once the stent is removed. The current case indicates complications can negatively impact the contralateral renal system.

Clinical Case: A 42-year-old Caucasian woman presents to the emergency room with severe right flank pain. Computed tomography imaging without contrast of the abdomen and pelvis showed severe right hydroureteronephrosis and a 7 mm distal right ureteral calculus. The left kidney and ureter were unremarkable. The patient had holmium laser lithotripsy to remove the calculus, and a double J stent was placed into the collecting system of the right kidney. The stent was removed four days post-surgery.

After recovery, the patient complained of dull, diffuse persistent left-sided pain at the level of the 12th rib. A retroperitoneal ultrasound of the abdominal arteries, bladder, and kidneys was performed four months post-surgery. While the right kidney was unremarkable, the left kidney showed slight hydronephrosis. The patient noted pain in the left flank when laying in left lateral decubitus for up to two years post-surgery.

Conclusion: We hypothesized that the contralateral pain is caused by an increased ipsilateral ureteral pressure due to ureteral reflux. The reflux is due to compensatory dilation and decreased peristalsis in the contralateral ureter. To reduce this negative and possibly permanent outcome, increased physician awareness and documentation regarding the propensity of secondary complications are needed.