Knotted ureteral stent: a rare complication of ureteral stent usage

Karagüzel, Ersagun; Kutlu, Ömer; Kazaz, İlke Onur; Gür, Metin; Dil, Eyüp; Özgür, Güner Kemal

doi:10.1007/s00240-012-0496-9

Cited by 10 publications

(10 citation statements)

References 12 publications

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“…This includes gentle traction, 8,13,14,16,18 ureteroscopic-assisted removal, 11,20 use of a stiff guide wire, 12,17 percutaneous removal, 9,10 open ureterotomy 15 and use of a holmium laser. 19,21,22 In four of our cases where we used holmium laser, three stents were successfully removed using this method. This method of removing knotted proximal stents was first described by Richards et al 19 and subsequently used by Karagüzel et al 21 and Nettle et al 23 We found this minimally invasive approach safe and reproducible and no complications were encountered.…”

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

“…4 Placement of ureteric stents is associated with welldocumented complications including stent migration, encrustation, fragmentation and patients being lost to follow-up. 3,[5][6][7] Knot formation of ureteric stents is a rare complication with only 15 cases reported in the literature at the proximal end, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] two cases reported at the mid-portion of the ureteric stent 23,24 and one case reported at the distal end. 25 We present five cases of proximal stent knotting in one institution over a one-year period.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Knotted proximal loop of ureteric stents: Review of the literature and five case reports

Ahmadi

Tran

Elms

et al. 2014

Journal of Clinical Urology

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Knotted proximal loop of ureteric stents: Review of the literature and five case reports

Ahmadi

Tran

Elms

et al. 2014

Journal of Clinical Urology

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“…However, some serious complications persist, including a separate cystoscopic procedure for removal, irritative voiding symptoms, hematuria, pain, infection, and encrustation. [1][2][3][4][5][6][7] With the widespread application of degradable materials in medicine, the degradable ureteral stent can provide temporary urinary drainage, decrease morbidity, and preclude a secondary procedure for removal. The dissolvable stent produced by Lingeman et al showed the unsatisfactory results of poor fixation and a tendency to drop in clinical trials, which caused hydronephrosis and left debris in the pelvis.…”

Section: Introductionmentioning

confidence: 99%

Characterization of nanostructured ureteral stent with gradient degradation in a porcine model

Wang¹,

Shan²,

Wang³

et al. 2015

IJN

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A tubular poly(ε-caprolactone) (PCL)/poly(lactide-co-glycolide) (PLGA) ureteral stent composed of nanofibers with micropores was fabricated by double-needle electrospinning. The stent was ureteroscopically inserted into six Changbai pigs, and the commercial polyurethane Shagong ® stent was inserted into four pigs as control. Intravenous pyelography revealed that the PCL/PLGA stent gradually degraded from the distal end to proximal terminal, and all stents were completely degraded at 10 weeks post-insertion. No significant difference was observed in hydronephrosis severity between the two groups. The levels of serum creatinine and urine pH remained similar throughout the study in the two groups, but the number of white blood cells in the urine was significantly higher in the Shagong ® stent group. On Day 70, histological evaluation indicated equivalent histological severity scores in the middle and distal ureter sections and bladder in the two groups. However, the PCL/PLGA stent-implanted pigs had significantly lower mean severity scores in the kidney and proximal ureter sites. These data revealed that the PCL/PLGA stent degraded in a controlled manner, did not induce obstruction, and had a lower urothelial impact in comparison to the Shagong ® stent, indicating that the stent exhibited great potential for clinical application.

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“…1 Minor complications of ureteral stents include pain, voiding symptoms, hematuria and infection, and major complications of stents include encrustation, fragmentation, migration, malposition, knot formation, forgotten stents, extrusion and death. [1][2][3] Ureteral stent migration is rare and involves movement within the urinary system. Stent extrusion is extremely rare and involves movement outside of the urinary tract, sometimes into critical organs such as the inferior vena cava 4,5 or duodenum.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous antegrade nephroscopic holmium laser pyelotomy: Novel endourologic technique for removal of extruded ureteral stent

Rhee

Steele

Beiko

2013

CUAJ

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Cite as: Can Urol Assoc J 2013;7(11-12):e830-2. http://dx.doi.org/10.5489/cuaj.1258 Published online December 5, 2013. AbstractUreteral stent malposition outside of the urinary tract is a very uncommon complication of retrograde or antegrade ureteral stent insertion. There are few reports of open, laparoscopic or endourologic approaches to remove malpositioned stents. We present a novel technique for the removal of an extruded retroperitoneal ureteral stent using percutaneous antegrade nephroscopic holmium laser pyelotomy. This previously undescribed procedure represents a new soft tissue application of the holmium laser. R etrograde or antegrade ureteral stent placement is a common practice to relieve upper urinary tract obstruction, pain, or infection.1 Minor complications of ureteral stents include pain, voiding symptoms, hematuria and infection, and major complications of stents include encrustation, fragmentation, migration, malposition, knot formation, forgotten stents, extrusion and death.1-3 Ureteral stent migration is rare and involves movement within the urinary system. Stent extrusion is extremely rare and involves movement outside of the urinary tract, sometimes into critical organs such as the inferior vena cava 4,5 or duodenum. 6Ureteral stent malposition is uncommon because of imaging techniques that are widely employed during stent placement. Ureteral stent malposition contained within the urinary tract lumen is often identified intraoperatively. However, malposition and extrusion of a ureteral stent outside of the urinary tract is extremely rare and may or may not be identified at time of stent insertion. We report a rare case of an antegrade malpositioned and extruded ureteral stent outside of the renal pelvis and its unique successful management via percutaneous antegrade nephroscopic holmium:yttrium aluminium garnet (YAG) laser pyelotomy -a procedure that has not been reported in the literature to date. Case reportA 78-year-old female presented with acute renal failure and bilateral hydronephrosis secondary to an obstructing, locally advanced and metastatic colorectal carcinoma. Serum creatinine was 922 μmol/L. Bilateral nephrostomy tubes and antegrade 8.5 Fr double J ureteral stents were placed by the interventional radiology service at our institution under ultrasonographic and fluoroscopic guidance. Within 3 days, the patient's creatinine returned to baseline (54 μmol/L) and both nephrostomy tubes were removed 5 days later. The patient was discharged in stable condition with indwelling bilateral ureteral stents. At initial follow-up 6 weeks after stent insertion, the patient reported mild intermittent gross hematuria, but no nausea or stent colic. Serum creatinine remained normal. Elective bilateral ureteral stent change was attempted under general anaesthesia 3 months later. Left-sided stent change was uneventful, despite a partially encrusted stent. The right-sided stent was not changed due to significant resistance that was met while attempting to remove it. The procedure was abandoned ...

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Knotted ureteral stent: a rare complication of ureteral stent usage

Cited by 10 publications

References 12 publications

Knotted proximal loop of ureteric stents: Review of the literature and five case reports

Knotted proximal loop of ureteric stents: Review of the literature and five case reports

Characterization of nanostructured ureteral stent with gradient degradation in a porcine model

Percutaneous antegrade nephroscopic holmium laser pyelotomy: Novel endourologic technique for removal of extruded ureteral stent

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