A Tiny Metal Coil That Stopped His Kidney Bleeding Later Turned Up Crusted in Stone Inside His Kidney
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But when surgeons went in with a scope to clear the latest stone, they found something else holding it together.
A metallic, wire-like object was poking into the kidney’s urine-collecting chamber, its surface crusted with stone. It was an embolization coil, a tiny device placed three years earlier to stop serious bleeding after a previous kidney stone operation.
Urologists at the University of California San Diego and Phramongkutklao Hospital in Bangkok described the case in Urology Case Reports in February. They call coil migration into the urinary collecting system an exceedingly rare complication that may cause stones to keep coming back.
Three years earlier, the man had undergone percutaneous nephrolithotomy, or PCNL, an operation that removes large stones through a small tunnel made through the back into the kidney. The surgery was complicated by significant bleeding.
Imaging found a renal pseudoaneurysm, a damaged artery leaking blood. Doctors sealed it with selective coil embolization, threading a catheter into the artery and placing a detachable coil, 2 millimeters wide and 4 centimeters long, to block the vessel. It worked, and the bleeding stopped.
The authors note that this approach is effective and widely accepted for bleeding after PCNL. The problem came later. A CT scan showed a kidney stone next to a bright linear density that suggested a foreign body.
The authors describe two ways a coil can end up in the urinary system. It may gradually erode through kidney tissue, or it may pass through a direct channel created by the earlier PCNL tunnel. Once the coil is exposed to urine, minerals can build up on it.
Similar cases have been published, but rarely. An earlier case report described a stone that resisted shock wave treatment because it had formed on a coil placed four years before. A 2014 report described a large stone that grew around a stainless steel coil placed in 2003.
The coil’s design may have played a role. Procedure records showed it was a Medtronic Concerto 3D detachable coil that, based on manufacturer specifications and operative notes, most likely contained nylon fibers.
Those fibers serve a purpose. They add surface area and promote clotting, which helps seal the damaged vessel. But in urine, the authors write, fibered coil material may make it easier for crystals to stick and build up.
That is their interpretation, not a tested finding. They conclude that the nylon fibers likely facilitated stone formation once the coil was exposed to urine, particularly in a patient with cystinuria.
His underlying condition matters. Cystinuria causes the amino acid cystine to build up in urine, where it can form stones, and the authors note that it carries a high risk of recurrence even without a foreign object.
That overlap can make cases like this easy to miss. A patient with a known metabolic reason for stones may simply be assumed to be having another ordinary recurrence, and a coil that has eroded into the collecting system can mimic a stone on imaging.
Still, the authors argue that metabolism alone does not explain what they saw. The recurring stones were consistently crusted onto the coil in the same kidney. That pattern, they say, supports the coil as a contributing mechanical factor, acting as a fixed core for new stones, rather than his cystinuria alone.
Composite stones built around metal can also resist standard treatment. In the earlier four-year case, two rounds of shock wave lithotripsy failed to break up the stone. The coil was discovered only when surgeons looked directly inside the kidney with a flexible scope and used a laser to remove the stone and the exposed part of the coil.
During ureteroscopy, a procedure in which a thin scope passes up through the urinary tract, the surgeons used a laser to break up the stone and cut away the exposed portion of the coil. They retrieved the fragments with a small basket.
They left the part of the coil embedded in kidney tissue where it was. Aggressively pulling out a deeply embedded coil carries a substantial risk of bleeding, the authors note, citing earlier experience removing eroded coils. They focused instead on clearing the stone and removing the exposed segment. There were no complications and no significant bleeding.
That choice carries a trade-off. The remaining metal could, in theory, become exposed again and seed future stones, so the authors recommend long-term monitoring.
As a single case, the report cannot say how often this complication occurs after renal embolization. Its practical message is aimed at clinicians: when stones keep returning in a kidney that once had coil embolization, a migrated coil belongs on the list of suspects. Patients who have had the procedure can help by making sure their urologist knows about it.
A small, flexible metal device placed through a catheter to block a bleeding or damaged blood vessel. In this case, it sealed a leaking kidney artery after stone surgery.
How did the coil end up where urine collects?
The authors suggest it either eroded gradually through kidney tissue or passed through the channel left by the earlier stone operation.
Once exposed to urine, the coil became a surface where minerals could build up. Its nylon fibers, meant to help blood clot, may have made it easier for crystals to stick.
No. Surgeons removed the stone and the exposed part of the coil but left the embedded segment to avoid dangerous bleeding, and they advise long-term monitoring.
No. The authors call coil migration into the urinary collecting system exceedingly rare, and only a small number of cases have been published.
Reported by medicaldaily.com.
Read Original Report at medicaldaily.com ↗
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