Midureteric knotted stent removed by percutaneous access!

Abstract

Indwelling ureteric stents are commonly used in the management of upper urinary tract obstruction. A rare complication is the knotting of an indwelling ureteric stent at its proximal coiled end. We present a case of a mid ureteric knotted stent that put the kidney at risk. Stent was extracted successfully by Percutaneous method, after failed minimally invasive methods.

Management of a patient with a double J stent knotted at the mid-portion

“…1 , 2 , 3 In contrast, only two cases of mid-portion and one case of distal loop knot formation cases were reported. 4 , 5 In 2002, Quek et al reported the first case of mid-portion knot formation in a double J stent, and managed successfully by gentle traction. 4 Bhirud et al reported that they could remove the stent by a percutaneous approach using a 26F nephroscope.…”

Knotted stents: Case report and outcome analysis

“…Our analysis of previous reports of knotted stent indicated that the male to female ratio is 3:1 and the mean age is 50 years (range, 4-86 years). The knotted stents were located in the upper ureter in 18 cases, the middle ureter in 2 cases, and the distal ureter in 1 case ( Supplementary Table 1 ) [ 4 , 5 , 6 , 7 , 8 ]. The most common reasons for stent placement were ESWL of a renal stone (9 cases), treatment of upper ureter stone or upper ureter obstruction (7 cases), to aid with anastomosis of the ureter (2 cases), periodic stent substitution (2 cases), and interoperative ureter determination (1 case) ( Table 1 ).…”

“…In two cases, the knotted stent was removed via PCN [ 4 ]. In the remaining case, a nephroscope was used to remove the knotted stent [ 8 ] ( Table 2 ). The exact PCN technique used was not specified, but nephroscopy is an invasive technique, requires general anesthesia, and may result in renal injury.…”

Management of knotted ureteral stent: A case report and comprehensive review of literature

“…Percutaneous retrieval has mostly been used as a secondary procedure instead of a primary as due to its invasive nature and has only been reported in 5 cases. One example is Bhirud et al [16] who performed it as a primary measure as they were able to access percutaneously to retrieve the stent due to preexisting tract created from the initial procedure of PCNL of the renal stone.…”