# Knotted and Encrusted Double J Stent: A Rare Complication Managed With Advanced Endoscopic Techniques

## TL;DR

A rare case of a knotted and encrusted urinary stent was successfully removed using advanced endoscopic techniques, avoiding the need for surgery.

## Contribution

This paper presents a unique clinical case and management approach for a rare DJ stent complication using non-surgical endoscopic methods.

## Key findings

- A knotted and encrusted DJ stent was successfully removed using a semirigid ureteroscope and lithoclast.
- Advanced endoscopic techniques can manage complex stent removal cases without requiring open surgery.
- Early follow-up and patient compliance are critical in preventing rare stent complications.

## Abstract

Complications related to double J (DJ) stent placement are well documented, but DJ stent knotting remains an exceedingly rare event. We present a unique case of a knotted and encrusted DJ stent, alongside a review of the literature on this rare complication. A 55-year-old man with a history of ureteral obstruction due to stones was managed initially with percutaneous nephrostomy (PCN) and DJ stent placement. The patient presented after a delayed follow-up for stent removal. Despite imaging showing no evidence of encrustation or knotting, cystoscopic attempts to remove the stent failed. Further evaluation, including ureteroscopy, revealed significant encrustation and knotting of the DJ stent at the renal pelvis. The stent was successfully removed using a semirigid ureteroscope and lithoclast without open surgery. This case highlights the importance of early follow-up and patient compliance in preventing such complications. When simple traction fails to remove a DJ stent, advanced endoscopic techniques such as lithotripsy and ureteroscopy should be employed to manage complex cases effectively.