Ask KidneyStoners.org: Do I have to have a stent?

February 25, 2012

“I have been diagnosed with an 8mm stone in my left kidney and told I would be going for lithotripsy to have is broken up and will need a stent inserted for about a month or so. I have a huge concern with the stent portion of this. After much research on and off the web, it seems out of all patients that have had a stent inserted post lithotripsy, about 80% to 90% of the time it has resulted in extreme pain and discomfort. To me, it seems like this “technology” is not yet ready for prime time. I am now going to forgo the lithotripsy and deal with the stone just to avoid having the stent! So my question is, can you offer any comfort on this seeming archaic practice of stenting. Is it a requirement? What is the down side of not stenting after the lithotripsy?”

Answer:

Stents have been used for decades and are not a new technology. Although much effort has been placed in trying to develop a pain-free stent, that goal has not yet been reached. As you point out, many patients do experience discomfort when stents are placed, although the percentage who experience “extreme” pain is likely lower than 80-90%.

Urologists will make a decision on whether to place a stent based on the type of surgery that is planned, the size of the stone being treated, whether a stone has been lodged for a period of time, the presence of other patient factors (renal impairment, solitary kidneys), and based on their own professional experience. Whether a stent is a “requirement” therefore can vary based on the patient, the stone, and the urologist.

The potential downside of not placing a stent is the risk of obstruction of the ureter due to either residual stone fragments or temporary swelling of the ureter after surgery. There may also be an increased risk of long term blockage (stricture) of the ureter if a stent is not placed in certain situations. However, a recent review article in the Journal of Urology found that among those undergoing uncomplicated ureteroscopy for stones in the ureter that were stented versus those that were not stented, there was no difference in the stone free rate, development of fever, unplanned medical visits, requirements for pain medication, or long term complications. Stented patients as expected had more stent related discomfort. Note though that these findings don’t necessarily apply to all stone patients as the study only included stones treated in the ureter with “uncomplicated” surgeries. (Pengfei and colleagues, “The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: A systematic review and meta-analysis”, Journal of Urology
2011.)

Ultimately, discussing with your urologist whether you are a candidate for having a procedure without a stent may be your wisest choice. An 8mm stone is large enough that it is not likely to pass on its own and in some cases an untreated obstructing stone can lead to kidney damage or other problems if it is ignored.

 

In our “Ask KidneyStoners.org” section, we field questions from stone formers or their family members. See previous questions and answers here.

About Dr. Mike Nguyen

Mike M Nguyen, MD, MPH, is a urologist and an Associate Professor of Clinical Urology at the Keck School of Medicine of USC in Los Angeles, CA. He specializes in the treatment of kidney stones with both surgery and dietary prevention and the in the treatment of kidney and prostate cancer using the latest robotic surgical approaches. He sees patients at clinics located in Los Angeles, Pasadena, and La Canada, CA. He is the founder of the www.KidneyStoners.org website.
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18 Responses to Ask KidneyStoners.org: Do I have to have a stent?

  1. Two years ago in March I had a stone and the urologist suggested laser surgery. The insurance would not approve so instead he did lithotripsy but did not work. During the same surgical procedure he decided to do Ureteroscopy and grab the stone but it did not work either. They left a stent (#1) in there, very painful, and sent me home. Two weeks later the insurance approved laser surgery. The laser surgery worked and they put another stent (#2) in there. I went through two more weeks of pain and then they removed the stent. The pain got worse for weeks and finally they realized the ureter folded causing Hydronephrosis. For a third time I had to go to the hospital and the doctor put another stent (#3) in there. This time after the removal the pain disappeared after 3 weeks and I was fine for almost 2 years till January this year when I experienced pain again in the same area. I thought it was another stone but they told me there was a stricture and I needed another stent to be placed in there to correct it. I had that stent (#4) put in there in March and the doctor left it in there for a month (very painful). It was removed in April and now it’s been 5 weeks and I’m still in pain. I certainly don’t want more stents put inside me, they’re painful inside and there is even more pain after the removal. I’m afraid something has gone wrong again and I have again hydronephrosis and might need another surgery and another stent place inside. On Monday I am having an ultrasound. What other alternatives are there for this problem? Are there any natural remedies?

  2. Michelle says:

    I am in 5 years remision butmy kiddney is failing i have a stent that hast to be replaced every 6 months but since my medicade droped me i cant aford the surgery help me pleaze

  3. Michelle Salinas says:

    Stent in my left kiddney have no insurancr and its been over a year and im in alot of pain

  4. gloria says:

    7 years i have been doing this battle i refuse to ever have another stent put in i was hospitalized twice after stent removal because i became septic i even went into a-fib because of the infection in my blood i will suffer through the surgeries and the removal of the stones but never another stent i have had 9 lithotripsies, parathyroids removed and still have stones or should i say boulders and my left kidney is a gravel pit getting ready for surgery in april percutaneous removal of a large stone not looking forward to this at all but so tired of constant infections that cause high blood pressure my heart goes out to all the men that go through kidney stones i gave birth to seven large babies all natural would do it again but the kidney stone are the worst

  5. Kerri says:

    I’m the first female in my family to get kidney stones and recently had a stent put in. It’s excruciately painful to bend over and just as painful when I pee! I’m hating it! I’m fearful of it coming out as I was informed I won’t be knocked out in surgery like I was when I was put into place. Not cool. I’m 42 yrs old and had to put my life on hold while I work all of this out. Not very happy right now.

    • Lis says:

      I feel your pain!! I have had a stent on for a week with a 6mm kidney stone says it was 7.5 but? Maybe it broke up a little? I have had 2 CT scans in 2 months time & in severe psi. With this stent! I hate it! I have to put my life on hold & my doctor wanted this in pre- surgery to break it up! They called & wanted me to wait 36 days hell no! I cried & said I cant take it anymore! I have to be on pain meds 24/7! Hurts to pee! If I’m not constantly drinking water or laying down on my heating pad! Which is a must!!! I woke up last night trying in horrible hortibke pain 6 days post surgery for the stent I was in horrible pain! Sweating! Ready to get sick! Trying not to so I could takeca pain pill!! I caught my breath took the pill- then a few minutes later got sick only a little and took a colder bath- laid in bed & was feeling better- bleeding was bad! I think maybe I pased a little of the stone today? Thank God I have surgery pushed up for two weeks post safety & not a month! Drink your lemon water- mountain dew or lemonade everyday if that’s going to help with these horrible stones that are being made!!! Worst pain ever!!!! Bladder feels horrible with pulsing spasums that don’t stop! Waiting for nightmare to be over!!

      • lis, did you have pain with you 6 mm stone, a month ago i was in the er severe pain and vomiting from my stone discovered on CT scan, have not had ANY pain since leaving the hospital, but don’t know if i have passed stone. follow up visit doc says still sees blood in my urine thinks i still have it. opted to have another ct scan before seeing him again in a week, its been 1 month no pain been drinking like crazy even more than normally do ( i drink a lot of water).. what made you do surgery were you in pain, i ‘m not in favor of any surgeries not having any pain feel like just waiting this out and see if my body takes care of it… passing tiny sand like stuff since when i do filter my urine.. so maybe it is breaking up… anyways just looking for opinions on to have the surgery or not, DON”T WANT a stent based on what i have seen on these posts.. your feedback on your situation would be helpful to me.. thanks i’m55 year old woman very active runner and play competitive tennis

  6. Charles Swift says:

    Get it out as soon as possible, longer it is in , more encrusted and tougher to remove. Also it has been my experience that the longer its in the more it hurts to pee right after removal. I understand it is in there for a reason, but as soon as the goal of the benifit of putting it in is reached ,, get it out. Many times I have had urologist take such a relaxed possition on this , all the while you are in excruciating pain, it can really really ware on you.

  7. Charles Swift says:

    Not true, any time I have had a stint in for more than 6 weeks it becomes incrusted and much harder to remove, to the point where it resulted in having to put another stint in for 24 hours because of the encrustment.

  8. Charles Swift says:

    I have been dealing with stones and stints for 20 years. Anything you want to know, just ask me . All the comments about pain when urinating with stints and blood is 1000% true. The pain and the blood are just part of the deal and it is bad. One thing worse , just imagin when the stint does not seet properly , pain x 10.

  9. Garry says:

    I’ve just had a lithotripsy procedure with stent..I’m having excructiating pain when urinating, there is still bleeding in the urine
    I’m into my fourth day now.
    Is this common?

    • James says:

      Yes. I have had mine for three weeks and the blood may come and go. It may be great one day and the next day look like u slit your wrists. Bloody horrible things. I am requesting I dot have one after stone is lasered. ( they had to put one in me as my ureter was not dilated enough ).

  10. Frank says:

    I had a stent removed yesterday. Procedure was short but very painful. Urination afterwards is much worse than with the stent, like a needle going into me every time. How long before this begins to improve? Been 24 hours so far with no change.

    • Charles Swift says:

      Very soon, drink lots of water or beer, whatever you have to do to keep peeing, not to much beer because the point is to stay hydrated right after stint is removed. I have had no less than 9 stints and the key for me was to stay hydrated, I have done it both ways , hurts alot more dehydrated. Ironicly I have a stint in me right now and am schedualed for a lithotripsy and the guy wants to take currant stint out , lazer stones, and then no stint , I think you need the stint afterwardsl

  11. Aneesh says:

    I had my stent for over 2 months now. will it harm in any way to have the stent left for so long?

    • Dr. Mike Nguyen says:

      Typically, stents can stay in for 3 months. The main concern is development of stones on stents. In some patients, this can occur rapidly while in other patients it may never happen. Most urologists will therefore err on removing or exchanging stents by 3 months. If no stones are seen on a stent by that time, some stents can even be left in place for 6 to 12 months. This is usually for long term issues with ureteral obstruction, not for stents placed after stone surgery.

      • Charles Swift says:

        All I can tell you doc is that it sounds like you never had a stint in youl It can be excruciating from day 1 until its out. I can not even come close to describing the level of pain. My neighbors have knocked on our door twice in the last week because of my screaming pain.
        Doctors always ask pain where is it on a 1 to 10 ? Ok doc , how about on a scale of 1 to 10 its about a 50

        • Lis says:

          I hear ya!!!
          I think they have never had this done before! I called & begged them to add me to the surgery list for two weeks post! I on severe pain! Pain meds every 4 hours!

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