Case Report: Knotted Ureteral Stent in Patient with Ileal Conduit: Conservative Approach for Retrieval

Abstract

A 70-year-old woman with an ileal conduit developed stones in both kidneys and the right ureter. A Double-J stent was placed to facilitate treatment of the stone on the right side. After nearly complete clearance on the right side, an attempt to retrieve the stent was unsuccessful because of a knot at the proximal end that was impacted at the ureteroilial anastomotic site. We describe removal of this impacted knotted stent with a conservative approach.

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

“…[11] Our patient developed renal colic, successfully treated with analgesic drugs, 8 hours after the extraction procedure. [14]…”

Midureteric knotted stent removed by percutaneous access!

“…[5] Previous reports have attributed knot formation to excessive length of the stent with one end abutting the wall of a dilated renal pelvis and then passing through the open loop,[23] stent configuration (Double-J or multi-coil), and flexibility and[1–3] anatomical abnormalities such as cystocele and ileal conduits. [67] For selecting optimal stent length, Breau and Norman advocated direct measurement of ureteric length from the X-ray and postulated that the optimal stent-to-ureter length ratio is 1.04. [8] A variety of techniques to deal with knotted stents have been described.…”

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

“…Simple traction has worked in the majority of cases (seven) and simple traction and delayed removal in one 6. Unknotting the stent has also been reported by passing a superstiff guidewire up the stent7 or under direct vision using 5F alligator forceps 8.…”