Bilateral Obstructive Uropathy Requiring Hemodialysis With Presumed Spontaneous Stone Clearance After Two Years of Forgotten Ureteral Stents: A Case Report.

Bilateral ureteral obstruction from urolithiasis is an uncommon but life-threatening cause of obstructive acute kidney injury (AKI). Double-J (DJ) stent insertion achieves emergent bilateral decompression and allows elective definitive stone management; however, the recommended stent dwell time varies by stent material and patient risk factors, as encrustation risk rises substantially after a few weeks to months of indwelling time. We report the case of a 78-year-old male with chronic kidney disease (CKD) who presented with bilateral proximal ureteral stones, severe AKI requiring hemodialysis, and a coexisting bladder stone. He was managed with bilateral DJ stent insertion and discharged, but was subsequently lost to follow-up for two years due to international travel. On return, both ureteral stones had undergone presumed spontaneous passage, confirmed by radiographic resolution on CT. Both stents were retrieved without complication, and no encrustation was identified. The persistent bladder stone was managed by cystolithotripsy at the same setting. Renal function at the two-year return visit remained stable relative to discharge, consistent with partial recovery and persistent advanced CKD. This report highlights the possibility of presumed spontaneous proximal ureteral stone clearance under prolonged stenting, the importance of structured stent follow-up systems, and the unexpectedly favorable outcomes achievable even with prolonged stent retention in the absence of documented urinary tract infection.