Alternative method of removing temporary implantable nitinol device (iTIND)

Objective We present a case of successful emergency iTIND removal using only commonly available emergency department supplies. Our objective is to describe a reproducible technique that may serve as a contingency method in urgent situations when standard removal kit is inaccessible. Patient and Procedure We present a case report of a patient who underwent iTIND placement and subsequently experienced persistent severe pain and urgency requiring emergency removal of the iTIND device using only supplies available in the emergency room (ER). First, cut off the tip of a 16 or 18 Fr-foley silicone or latex catheter. Silicone catheter is preferred. Then, thread a 2-0 silk suture on a straight needle through the entire length of the catheter and tie the retrieval suture to the silk suture. Next, lubricate the tip of the catheter in preparation and pull the retrieval suture through the catheter. Next, pass the catheter into the urethra while your assistant holds back pressure on the suture. Next, retract the device into the catheter by pulling on the suture. Once the device is retracted into the catheter, remove the catheter along with device intact from the patient. Results This technique was successfully utilized in one patient using an 18-Fr silicone Foley catheter. Device removal was completed without complications. Conclusion The iTIND device can be safely removed by this alternative method with equipment found in the average emergency room; however, understanding of the device mechanism and its position in lower urinary tract anatomy is necessary.