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

Ureteral stents are safe, and because of their widespread usage, complications associated with stenting increased. The knotting of the ureteral stent is an uncommon complication. Until today, only three cases of knotting at the mid-portion and distal ends of the ureteral stents were reported. Herein, we report a rare case of a downward migrated ureteral stent with a knot in its middle portion at the level of the distal ureter in a 25-year-old female patient. Her knotted stent was successfully removed by guidewire insertion and ureteroscopy under fluoroscopic guidance.