A knotted ureteral stent: A case report and review of the literature

Abstract

The indications for ureteral stent placement have expanded significantly with the progress of surgical procedures and techniques. Although such stents are now an integral part of contemporary urological practice, their use is not free of complications and consequences. There are very rare descriptions of knot formation in a ureteral stent and the consequences of this occurrence, with only 12 cases previously reported. Here, we report an additional case and review all the literature concerning this urological complication with emphasis on its predisposing factors and conservative and surgical management.

Novel application of an established technique for removing a knotted ureteric stent

“…Only 14 previous cases are reported in the international literature and the majority of them have been in the upper ureter 4. As with our case, most of them have involved the usage of the multilength stent (10 out of 14) and this is probably due to the fact of the increased amount of actual stent length that is coiled within the kidney.…”

Successful Treatment of Stent Knot in the Proximal Ureter Using Ureteroscopy and Holmium Laser

“…The most common method is simple traction [2]. While trying to apply simple traction in our case, we encountered resistance and the knot become even tighter.…”

Ureteroscopic Holmium Laser Ablation of a Knotted Ureteral Stent

“…9,[10][11][12][13][14][15][16] This, however, can pose the risk of ureteral avulsion. Various adjuncts to traction were used, such as shockwave lithotripsy in a patient with an encrusted proximal end 8 and the insertion of lubricant combined with rotation of the stent in a patient with an ileal conduit.…”

“…A rare complication is knotting, with associated difficult removal having being reported in only 15 previous cases. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] A wide range of methods for removal has been presented, including short-and long-term traction, ureteroscopic assisted removal, use of a stiff Amplatz type guidewire, percutaneous removal, and most recently, one case describing ablation of the knot with holmium laser. 7 We present an additional case describing our eventual choice of holmium laser ablation to remove a proximal knotted Double-J stent and a literature review of other methods previously used.…”