Ureteral stents are commonly used in urologic practice and have a number of well recognized complications. A rare complication is knotting with associated difficult removal having been reported in only 15 previous cases. Various methods of removal have been described. We report an additional case in which a ureteroscopic holmium laser was successfully used to remove a knotted ureteral stent. A literature review of all previous cases of this rare complication is also presented.
Get full access to this article
View all access options for this article.
References
1.
ZimskindPD, FetterTR, WilkersonJL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol, 1967; 97:840–844.
2.
PazA, AmielGE, PickNet al.Febrile complications following insertion of 100 double-J ureteral stents. J Endourol, 2005; 19:147–150.
3.
RembrinkK, GoepelM, Meyer-SchwikerathM. The forgotten double J stent. Case report of multifractured ureter stent. Urol Int, 1992; 49:119–120.
KatskeFA, CelisP. Technique for removal of migrated double-J ureteral stent. Urology, 1991; 37:579.
6.
SchulzeKA, WettlauferJN, OldaniG. Encrustation and stone formation: Complication of indwelling ureteral stents. Urology, 1985; 25:616–619.
7.
RichardsMM, KhalilD, MahdyA. Successful treatment of stent knot in the proximal ureter using ureteroscopy and holmium laser. Case Reports Med, 2011; 2011:502191.
8.
FlamTA, ThiounnN, GerbaudPFet al.Knotting of a double pigtail stent within the ureter: An initial report. J Urol, 1995; 154:1858–1859.
9.
DasG, WickhamJE. Knotted ureteric stent: An unusual urological complication. J R Coll Surg Edinb, 1990; 35:190.
10.
PicozziS, CarmignaniL. A knotted ureteral stent: A case report and review of the literature. Urol Ann, 2010; 2:80–82.
11.
RivaltaM, SighinolfiM C, MicaliSet al.Knotted ureteral catheter in an 83-year-old man: Case presentation and urological non-invasive management in the elderly. Urol Res, 2009; 37:261–262.
12.
EisnerB, KimH, SaccoD. Repeat knot formation in a patient with an indwelling ureteral stent. Int Braz J Urol, 2006; 32:308–309.
13.
CorbettHJ, DicksonAP. Knotting of a ureteric stent in a child. Int Urol Nephrol, 2005; 37:493–494.
14.
SighinolfiMC, De StefaniS, MicaliSet al.A knotted multi-length ureteral stent: A rare complication. Urol Res, 2005; 33:70–71.
15.
QuekML, DunnMD. Knot formation at the mid portion of an indwelling ureteral stent. J Urol, 2002; 168:1497.
16.
GroeneveldAE. The role of ESWL in the treatment of large kidney stones. Singapore Med J, 1989; 30:249–254.
17.
BaldwinDD, JurianszGJ, StewartS, HadleyR. Knotted ureteric stent: A minimally invasive technique for removal. J Urol, 1998; 159:2065–2066.
18.
BasavarajDR, GillK, BiyaniCS. Case report: Knotted ureteral stent in patient with ileal conduit: Conservative approach for retrieval. J Endourol, 2007; 21:90–93.
19.
KondoN, YoshinoY, ShionoY, HasegawaY. [A case demonstrating knot formation at the upper end of a ureteral stent.](Jap) Hinyokika kiyo, 2005; 51:385–387.
20.
KundargiP, BansalM, PattnaikPK. Knotted upper end: A new complication in the use of an indwelling ureteral stent. J Urol, 1994; 151:995–996.
21.
BraslisKG, JoyceG. Spontaneous knotting of a pigtail ureteric stent in the ureter requiring percutaneous removal. Aust N Z J Surg, 1992; 62:825–826.
22.
GrassoM. Experience with the holmium laser as an endoscopic lithotrite. Urology, 1996; 48:199–206.
23.
KampS, KnollT, OsmanMMet al.Low-power holmium:YAG laser urethrotomy for treatment of urethral strictures: Functional outcome and quality of life. J Endourol, 2006; 20:38–41.
24.
LaneBR, DesaiMM, HegartyNJ, StreemSB. Long-term efficacy of holmium laser endoureterotomy for benign ureteral strictures. Urology, 2006; 67:894–897.
25.
GillingPJ, KennettK, DasAKet al.Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: An update on the early clinical experience. J Endourol, 1998; 12:457–459.
26.
SejinyM, Al-QahtaniS, ElhaousAet al.Efficacy of flexible ureterorenoscopy with holmium laser in the management of stone-bearing caliceal diverticula. J Endourol, 2010; 24:961–967.
