Ureteral Stapler Nail Misdiagnosed as Ureteral Calculus: A Case Report and Systematic Review

Abstract

Purpose: Cases of ureteral closure nails misdiagnosed as calculi are rare. This case report and systematic review provide additional information on diagnosis, imaging features and treatment options.

Patients and methods: A 56-year-old male presented with right hydronephrosis and lower ureteral calculi. Preoperative abdominal radiography and urinary CT diagnosed calculi (Figure 1ab). Intraoperative ureteroscopy revealed a metallic foreign body (closure nail, Figure 2a), combined with the patient’s history of sigmoid colon cancer surgery six years prior confirming the diagnosis of migrated closure nail. A systematic review adhering to PRISMA guidelines was conducted by searching PubMed, Web of Science and other databases (1980-2020) using the keywords ureteral foreign body.

Results: The closure nail was successfully removed intraoperatively (Figure 2b). Due to ureteral stricture, further surgical interventions (holmium laser incision or ureterovesical reimplantation) were required. The systematic review included 54 cases of ureteral foreign bodies, predominantly iatrogenic devices (38%) and metallic objects (25%). Distal ureteral obstruction was most common (44.4%). Minimally invasive treatment achieved a 92% success rate, with CT/MRI diagnostic accuracy improving to 97% in the past decade.

Conclusions: Ureteral foreign bodies require detailed medical history and imaging to reduce misdiagnosis risks. Minimally invasive techniques, such as holmium laser, are preferred. Clinicians should avoid ureteral injury during intestinal surgery and remain vigilant for postoperative foreign body migration.