Bilateral forgotten double-j stents with high-grade encrustation (fecal grade 4-5): renal loss and staged multimodal management - a case report.

INTRODUCTION AND IMPORTANCE: Forgotten ureteral double-J (JJ) stents with high-grade encrustation (FECal grade 4-5) represent a severe and preventable urological complication. We report a case illustrating the catastrophic consequences of a failure of 24-month follow-up, culminating in irreversible renal loss and complex three-stage contralateral management. CASE PRESENTATION: A 65-year-old man (ASA II) presented 24 months after bilateral JJ stent placement (Boston Scientific, 7 Fr, 26 cm) for obstructive pyelocalyceal stones, without follow-up. The presenting complaint was left renal colic. The workup revealed a serum creatinine of 97 µmol/L (eGFR ~80 mL/min/1.73 m2), a CRP of 20 mg/L, a WBC count of 8000/mm3, and a positive urine culture for Klebsiella pneumoniae. CT demonstrated bilaterally calcified stents and an atrophic left kidney. Bilateral percutaneous nephrostomies were performed; DMSA scintigraphy confirmed left renal function below 10% (FECal Grade 4, left; FECal Grade 5, diffuse right). CLINICAL DISCUSSION: Left-sided management comprised laparoscopic nephrectomy with same-session cystolithotripsy; the stent was deliberately transected upon encountering resistance during extraction (stay: 5 days). Right-sided management required three sequential stages: cystolithotripsy, rigid ureteroscopy (three weeks later), and planned flexible ureteroscopy (fURS) for a 15 mm proximal coil calcification and three small inferior calyceal stones in a solitary kidney. Creatinine remained stable throughout. No postoperative complications were recorded. CONCLUSION: This case underscores the devastating consequences of forgotten stent syndrome. Individualized multimodal planning and the principle of never forcing extraction are critical surgical tenets. Every institution performing JJ stent placement must implement a stent-tracking registry, automated reminders, and structured patient education at insertion - measures that would have prevented this outcome entirely.