Case: 222

Right Ureteral Stent Malpositioning

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History: 73 yo female with history of bladder cancer and associated renal obstruction
Solution: The critical finding on the post-operative film is that the right ureteral stent does not take the expected course. The tip ends up more medial and superior than would be expected based upon the patients anatomy. This could be explained if the patient was obliqued, but they are not. Following this up showed that the stent had perorated the ureter and was no longer within the ureter. It was injected with contrast to confirm, and the stent was pulled back into the ureter at that time.

CT Images

Questions

What is the next best step?
  • Nothing (expected findings)
  • CT scan of abdomen and pelvis
  • Observation
  • Re-operation
  • Fluooroscopic study
The most common cause of bladder cancer is smoking.
True
Please describe any unexpected findings on the post-operative film.
Right ureteral stent malposition