An unusual case of intrarenal coiled and ruptured guidewire

OBJECTIVE: To the best of our knowledge there are only 3 reports of fractured guidewires inside the pelvicalyceal system, successfully removed with endourology techniques, and this is the first one presenting a tightly coiled intraparenchymal section. MATERIAL AND METHODS: A 59-year-old woman was hospitalized for surgical treatment of a right kidney of reduced size. Past history revealed pyelolithotomy for a staghorn stone 14 months earlier at another Institution with subsequent ureteral obstruction, one failed attempt at ureteral double-J catheter insertion and one failed attempt at percutaneous nephrostomy placement 5 months postoperatively. Another nephrostomy was placed, but left indwelling briefly. CT scan demonstrated a small-size kidney with residual stone fragments and presence of a "device" in the lower pole. The tapered distal extremity of an hydrophilic guidewire, with a tightly coiled central section wedged in the renal tissue was found inside the nephrectomy specimen. RESULTS: While the Radiologist who read the CT scan hypothesized that the "device" was a fragment of double-J ureteral stent or nephrostomy catheter, it consisted of the hydrophilic extremity of a guidewire, broken during a previous attempt at nephrostomy placement. Perirenal fibrosis and inappropriate angle between the needle and the lower calyx are the likely causes of guidewire coiling during its advancement and subsequent rupture during withdrawal. CONCLUSIONS: Urologists must be aware that, although percutaneous nephrostomy has a very high technical success rate, unusual complications like guidewire fracture may occur, and that modern imaging techniques can provide an accurate picture of this condition