Forgotten double-J ureteral stents: clinical burden, complications, and predictors of encrustation in a Tertiary Care Center

Abstract Background Forgotten double-J (DJ) ureteral stents represent a preventable complication with significant morbidity. Limited data exist on patient-level determinants and systematic risk factors in low- and middle-income countries (LMICs). This study primarily evaluated the burden and clinical consequences of forgotten DJ stents and secondarily identified independent predictors of stent encrustation at a tertiary care center in Pakistan. Methods This retrospective observational study included patients with DJ stents retained 3 or > 3 months beyond the advised removal date without clinical justification, from May 2023 to April 2025. The primary outcome was encrustation. Multivariable logistic regression identified independent predictors of encrustation, with multicollinearity assessed using the variance inflation factor (VIF). Spearman’s correlation evaluated the relationship between stent duration and complication severity. Results Ninety-four patients were included (64.9% male; mean age 41.3 ± 12.2 years). The majority (86.2%) had not completed high school, reflecting low overall educational attainment in the cohort. Total stent dwell time was 3–4 months in 45.7%, 4–6 months in 18.1%, 6–12 months in 16.0%, 12–24 months in 17.0%, and > 24 months in 3.2%. Primary reasons for delay were unawareness (50%), financial constraints (24.5%), and neglect (11.7%). Complications included encrustation (43.6%), stone formation (22.3%), fragmentation (18.1%), and migration (16%). Single-session removal succeeded in 64.9% of patients; 25.5% required two sessions, and 9.6% needed more than two interventions. One nephrectomy was performed (1.1%). On multivariable analysis, factors independently associated with encrustation were low educational status (adjusted OR 9.72, 95% CI 1.66–56.82, p  = 0.012) and stent dwell time > 6 months (adjusted OR 23.39, 95% CI 6.64–82.38, p  < 0.001). A strong positive correlation existed between stent duration and complication severity (ρ = 0.62, p  < 0.001). Conclusion Forgotten DJ stents caused substantial morbidity, with low educational status and prolonged retention independently predicting encrustation. Gaps in patient education and follow-up systems persist in resource-limited settings. Stent registries, automated reminders, and targeted counselling may help reduce this preventable complication.