Incidental Finding of Intrarenal Foreign Guidewire During Percutaneous Nephrolithotomy: A Case Report and Literature Review

Abstract

Patient: Male, 54-year-old Final Diagnosis: Foreign body in the abdominal cavity Symptoms: Flank pain Clinical Procedure: — Specialty: Urology Objective: Challenging differential diagnosis Background: Percutaneous nephrolithotomy (PCNL) is indicated for large renal calculi (³2 cm) and is often the treatment of choice due to its high success rate. Guidewire fragmentation is a rare procedural accident that can occur in PCNL but may be missed. Retention of the fragment within the upper urinary tract can lead to further compli-cations, such as recurrent nephrolithiasis or impairment of renal function. Case Report: We present the case of a 54-year-old man who experienced right flank pain for 5 days. His history was significant for recurrent nephrolithiasis, managed by PCNL in other hospitals. The most recent procedure was con-ducted 4 years ago, and his perioperative course was uneventful. Preoperative computed tomography revealed right renal calculi and a C-shaped foreign body. He was scheduled for an elective PCNL. The foreign body was intraoperatively identified as a guidewire fragment and removed. Conclusions: Currently, there is no standard management for intrarenal foreign bodies. Suspicion should be raised in young patients with recurrent stones within a short period of time. A thorough history on past urological interventions should be obtained. Symptoms can also have an insidious onset that could mimic nephrolithiasis or urinary tract infections. Extraction can be done via a standard minimally invasive approach. It is also the surgeon’s responsibility to check the integrity of intraoperative instruments so as to minimize risks of complication and reassure the patient.