How is a ureteral stent removed?

Diagram of a ureteral stent in position.We previously went over how to place a ureteral stent. In today’s post, we go over the steps of removing a stent. Ureteral stents are removed using two basic methods:

1) By pulling on a stent string, if the string was left in place.

2) Placing a camera into the bladder (cystoscopy) to directly see and grab the stent with a small grasping device.

Removing a stent with a string left in place:

In some cases, your urologist will leave a string attached to one end of a ureteral stent. The stent string is a long piece of thread that will start from the stent and drape out the urethra, where it is visible at the urethral meatus (where urine comes out). A diagram and photos of a stent with a string attached are shown below.

To remove the stent, the visible string is firmly held and steady continuous pulling is applied until the entire stent comes out. The curls at the end of ureteral stent are flexible, so the stent should uncurl and come out easily.

What’s the advantage of leaving a string?

  1. The stent can be removed without performing cystoscopy.
  2. Patients can remove their own stent without waiting for an appointment or having to come to the office.
  3. Stents can’t be “forgotten” when a string is attached. When no string is left attached, a patient may forget or not realize that a stent was left in place. Over time, these forgotten stents can form large stones on them, making removal very difficult.

What’s the disadvantage of a string?

  1. The string can get snagged on clothing or be pulled on accidentally, resulting in a ureteral stent being removed earlier than it was supposed to. This seems to more commonly occur with female patients.
  2. The string can be a minor annoyance.
  3. Some patients prefer not to have to remove their stents themselves at home using the string. They however can usually come to the office where the staff can perform this for them.

Removing a stent by performing cystoscopy (with video below):

When no string or only a portion of the string is left attached, your urologist will need to use a camera to enter your bladder through your urethra. He or she can then see the stent and use an instrument to securely grasp it and remove it. The process is usually quick and occurs in the clinic. It takes only a minute or so in most cases.

Steps in removing a ureteral stent with cystoscopy

  1. Use a cystoscope to enter the bladder. (A cystoscope is a camera that can be placed into the bladder).
  2. Identify the stent.
  3. Use a grasper to securely grab the stent.
  4. Remove the cystoscope, grasper, and the secured stent as one unit.

The video at the bottom of the page demonstrates all these steps.

How uncomfortable is stent removal using a cystoscope?

For the majority of patients, stent removal is not as uncomfortable as they expected. We often have patients react in surprise when they learn that the stent has been already been removed and the procedure is done.

Unfortunately, some patients do experience discomfort with stent removal, more commonly in men because of their longer urethra. This can be due to discomfort from the cystoscope itself or from the sensation of the stent being removed. While most patients do not feel the stent actually sliding when removed from the kidney, some do experience an uncomfortable sensation with this.

Is there anything that can be done to make it more comfortable?

  • Lidocaine jelly placed into the urethra at the beginning of the procedure will help to numb the area but will not completely take away sensation.
  • In men, and also occasionally in women, increased discomfort is related to tightening of the urethral sphincter as the scope is passed into the bladder. Trying to relax, take a deep breath, and not “clench” down during the cystoscopy process can sometimes make the process less uncomfortable.
  • Anticipation and perception also seem to play a role: Researchers have found that patients who watch their own cystoscopy procedure on a video screen experienced less discomfort than those that did not.

Video of ureteral stent removal in a male patient.


Pain after stent removal:

In most patients, stent removal is a relief as their stent discomfort goes away. However, in some patients, severe pain may occur for several hours. This is thought to be due to spasms of the ureter or swelling and temporary blockage developing after the stent comes out.

Not enough is known about this phenomenon but one recent study suggests it may occur in as many as half of patients. In the study, patients given a single dose of rofecoxib did not experience this pain while those given placebo developed it in 55% of cases. Rofecoxib went by the brand name Vioxx and is no longer available in the U.S. as it was withdrawn by the manufacturer.  The authors of the study report they now use naproxen as an alternative. You can read more about the study in our post “Severe pain after stent removal: How often does it occur and can anything prevent it?”

If you are thinking about trying naproxen, be sure to read the manufacturer’s warnings as some patients should not take the medication and check with your doctor first to make sure it’s okay in your situation.


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 website.
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366 Responses to How is a ureteral stent removed?

  1. Sandy says:

    The entire concept of stent placement is very controversial and barbaric at best. You would think with all the extreme adverse side effects – pain,nausea,vomiting, inability to urinate, insomnia, lost wages ,etc.- urologists would use a more conservative approach in their placement. Stents occlude urine flow and promote stone growth and infection as frequently as they prevent it. Shouldn’t they be placed only when diminished urine flow is proven. What is the diameter of a stent’s drain hole and inside diameter versus your own ureter? Who the heck designs and approves of these barbaric devices. The number one complaint is urinary urgency and frequency- of course there’s a coil of plastic tubing rubbing against your interior bladder wall that causes it to continually spasm. Why does that end of a stent have that design feature. Why is there such a big “J”tail left to torture almost every patient? How is it posible stent sizing is not customized to diminish or decrease this horrible side effect. Way to go MDs. Don’t know how you can even begin to think this procedure causes ” minor discomfort” ! This isn’t the cure for cancer just some basic “plumbing basics ” urologist bluff their way around hundreds of times a week. Way to raise the standard of care and put your patients first!!! Deceptive, painful, avoidable, and mostly unnessisary. Wonder how many years from now this therapy will be a shameful bad memory?

  2. Eric says:

    I am having a stint removed in a few weeks. My kidney was blocked for along time by a 8mm stone in the ureter tube. I have long term pain management with lower back damage at L5 with a spinal fusion. I am really dreading the stint removal the most because of a childhood ‘ trauma ‘ related to not wanting strangers touching my…….. Yet after reading this forum, I feel a little better.

  3. Amanda ashley says:

    I want my gone will it hurt to pull out myself

  4. Rachel Butler says:

    So I found out I had a kidney stone at the end of October at about 24 weeks pregnant. The pain wasnt too bad and the Dr in the er said he didn’t see anything on the ultrasound so its probably so small I should pass it easy. Well the pain went away an ld I thought it was over.
    A week ago Teusday I went back because the pain was too intense. They gave me some percoset and sent me home and said the stone is probably moving so thats a good sign.
    Last saturday I was in so much pain I was screaming and crying. Go back in, they do another us and turns out there was a 6mm stone causing a blockage. Ive never been in so much pain. They ended up having to do surgery to remove the stone and place a stent. Ive never had surgery and I had a miscarriage last january so needless to say I was terrified. I had two choices of anastesia to be put under or have a spinal. The surgeon reccomended going under so thats what I did. They monitored baby throughout and i came out fine.
    The pain that stent caused was almost worse than the stone. I peed blood for days. Every time I moved or breathed deep it was like a stabbing in my kidney. I felt like I always had to pee and when I did go it was incredibly painful. I barely slept all week.
    They left the string on the end of the stent so I could remove it myself. I was really scared to do it but your comments and stories today made me feel so much better. I took a percoset 45 mins before I was ready to do it. Then i turned on the shower and laid down in the tub. I grasped the string and just slowly pulled. It came out a little at a time, it wasnt painful but a little uncomfortable until the end came out and it hurt just a little like a pinching. Then it was out. Once it was out I literally cried because the relief was immediate. I felt a million times better. Its a few hours later now and the only pain im experiencing is a little burning when i pee. I feel so much better having that thing out.
    Stay calm and be patient. Use a heating pad while you have the stent in and just remember once its out you will feel so much better!!!

    • Lee Collins says:

      I’m stunned. Reading your story feels like my own, and that I could have written it! I am going through the exact same agonizing pain!!! The only thing is I have to wait a couple of more weeks for removal. The string was not left attached.

      Thank you for your story! I feel better knowing it’s “not just me”…


  5. John says:

    I had a stone removed yesterday and a stent put in with a string. Today, while taking a shower, I noticed that the string is no longer there. I am not sure what happened. I am a male and while finishing up peeing, I might have pulled it into my body.

    Not sure what to expect or what to do.

    Anyone else with a similar experience?


  6. Marc says:

    I had an eight mm stone taken out 5 days ago via laser/basket etc…as you know, very awful. My doctor did use a ‘stitch’ so that it could be pulled out at home today. My anxiety was through the roof to the point where I asked my wife to be a trooper and pull it out. The doctor had told my wife post op that I would need to pull it out ‘like a tampon’ smooth and consistent without stopping. Of course, I never had pulled out a tampon so that was confusing….how fast is that?

    I put a bag of ice to numb the area…stood in the shower with the water running, and she pulled it out…there really was zero pain. It was so quick and very relieving, both physically and mentally. it does slide right out without a pulling feeling, no resistance, no pain. It did give the sensation that I was urinating for a second or two, I turned into the shower and felt nothing. I hope this helps.

  7. suresh says:

    Guys removing of dj stent from dr.its only haff minute procedure
    Very tiny pain u feel and its so easy so pls don’t take hadeqe its very easy..

  8. This whole kidney stone issue has been horrible. I’ve had 3 children and in labor several hours, but the pain I had before the surgery was worse than child birth. I’m 73 years old and have always been so active, but this has really brought me down. I get my stent taken out this Monday. I hope it won’t be too bad and I hope to God I never get another kidney stone.

    • monique says:

      I hear you. I have had the worst experience too. Nausea, discomfort, pain, vomiting, time off work, in bed for going on 3 days now, stent is a horrible thing…afraid to bend or move so I just sleep in a Percocet dazee, then someone wakes you, then comes the flank pain and nausea again and urine pain and just drinking all that water and feeling nausea and vomiting water. So glad when I will feel better. I am self removing my stent tomorrow morning. So afraid ….I also wasn’t told to try to get a sample of the stones so how will I know what kind I had so that I can change my diet? Never want another stone again. Mine was 1 cm long.

      • monique says:

        also adding that the constant urge to urinate for going on 3 days has got to be the worst feeling so going to bed an staying there and not moving and wearing Tenas helped.

    • Charlene S. says:

      I ha a 6mm kidney stone removal/ureteroscopy one week ao today. Told the stent will be removed in office after 2 week (next week). I cannot stand the pressured feeling of wanting to pee constantly (at least every 10-15 min)…Drs nurse sugg. a sample opf Vesicare to take and it seemed to calm my overactive bladder symptoms for two days and it died down. Now Im experiencing another sensitivity issue but not to that extreme. Thank you all for your replys as we who dont know are finding solace with your dilemas, I mean to say your advice helped me somewhat for now. I just wish Drs could give us a heads up on some of the things to expect instead of me panicking when I couldnt reach someone on a weekend! And I take a diuretic for BP! Cant wait for next week to get this removed-hope nothing else becomes an issue then. Good luck to you all.

  9. Greg says:

    Thanks to all who have posted here. Reading these gave me a clear understanding of what to expect when removing the stent (and the motivation to take care of this myself). Took a couple of Advils, was relaxed and standing, and started pulling. Closing my eyes helped.

    Unpleasant but not intensely painful. Just when I was concerned that the thread was slipping, the loop of the stent appeared. Taking hold of that was much better and I could pull more confidently. Tensing up was painful…it was definitely better when I relaxed as if urinating, and each time I relaxed, the stent moved more freely. It seemed to go on and on, then abruptly the loop on the far end literally popped out.

    A little sore, but I feel so much better with the stent gone. No comparison to the previous constant, unpleasant need to relieve myself and the sharp burning sensation that went with it. Take care, all.

    • Abby says:

      I currently have a stent in for the first time and have to remove it myself on Monday. I’m really nervous about pain so was doing some reading on line. Your post kind of eased my mind. Though I am a woman so not sure if it will be different. Either way, just hoping it doesn’t hurt too bad. Though I feel like the pain from my 5mm stone trying to tear its way out of my body set me up for being able to handle almost anything now.

      • Tami schultz says:

        I had my stent put in on Friday at 145 pm
        The string drove me crazy and was uncomfortable. Blood in urine is gone. Stent to come out on Tuesday but I pulled it out today. What a relief. Just pull on the string like a tampon in one consistent pull. No pain. Relief thank god. No worries

      • Greg says:

        All the best tomorrow, and as Tami commented, might possibly be easier for a woman. Whatever the case, with some light pain reliever taken approx 15-30 minutes beforehand, I found the toughest part of it all was the very first couple of seconds.

        As others here have mentioned, the anticipation beforehand was much worse than the actual event. Take care- I bet you’ll feel great afterward.

  10. Lorraine says:

    Had an 8 mm stone show up on a CT scan back in March of 2010. I had other health issues going on at the time and the Dr. stated that I had bigger things to worry about at the time…. fast forward to Sept. 2015. Never had an ounce of pain from that stone until it decided to break apart and block the ureter! I’ve had three children back in the day before epidurals and I can safely say I would rather have a baby any day… A stent was placed and I had lithotripsy three weeks later. They didn’t have to blast the stones and were able to remove them intact. Another stent was inserted to aid in healing and is due to come out tomorrow morning. I have had great anxiety for the past three weeks waiting for this nightmare to be over…. reading the comments have helped ease my over active mind tonight. I’ll check back in tomorrow. Hoepfully I can ease another anxious soul!

  11. bryan says:

    Had that shock surgery to break up stone with a stent placed. After waking up the pain in my kidney was awful on1 to 10 id say 15 when i got home i was on the flooR the next morning the pain so i thought was gone i had to pee so went to bathroom like alawys standimg there as i started to i droped to my knees for the next four days only way i could urniate was in the bathtub under hotwater still hurt bexause of urthria musals spasams day five getting better able to sit on a toliet at times and go day six finaly able to stand and urinate today is monday day7 barely on pain meds now and able to pee however tomorrow suposed to have x ray and if stones gone stent removal same day ill die before they ever do this surgery again. Not trying to scare anyone this was just my experiance first uroligy is who done mine i feel like the doctors and nirses did a good job all was pro. And polite hell they even gave me a shot to numb my hand before inserting iv was unaweare they could do this never felt iv like that a lot hate urination with a stent

  12. Kimberly Conley says:

    I don’t understand!! They had to put me asleep to put my stent in but I’m going to b wide awake for them to remove it!!! I’m having this done in about 8 hours and I’ve so nervous I can’t sleep!!! I’ve had nothing but pain since it’s been in (one month today) and I’m not wanting to bear MORE pain to remove it!!! I’m not a baby about pain, hell I’ve two knee replacements and had a baby so I can able most of the pain I’ve dealt with but I’m not happy about this stent removal at ALL!!!!

    • Donna says:

      I feel the same! How was it? I’ve had mine in since 9/14, had a lithotripsy two days ago and the stent is coming out next week. I DREAD IT!!

      • mickey says:

        i have had stent in for 5 want to do lipotripsy 12-17-15.i have had 2 treatments already. stone was 2.4 cm and now is 1cm.(still very large) i am very uncomfortable and can’t wait till it is removed

  13. Awais Malik says:

    is stent removel process is done without giving any kind of anthesizya?

  14. Jan Wesselius says:

    Had my stint removed today, Now at home with minimal pain, Just took some Tylenol 3’s and fee fine.. The pain is in the kidney area. The removal was almost painless, they numbed it up with the gel and as I watched on TV the whole thing took 15 seconds if that, Little bit of pain going up the urethra, mostly a weird sensation I can live without. He grabbed it an out it cam in 3 seconds. No bleeding or hurt when I urinate. I just wish the previous part of the stone removal went as smoothly. Now that whole procedure was horrible, pain, burning, bleeding and it seemed the pain from the stones were less than the cure.

  15. Bob says:

    I had my stent removed this morning. I was extremely nervous about the process after reading all the horror stories. Overall it wasn’t that bad. The doctor first applies some numbing agent into the penis (this was a little uncomfortable but no pain). He then let it sit for 10 min. He came back into the room with a nurse and they began the procedure. Because I was freaked out already I put a pillow over my face because I didn’t want to see what they were doing. It took all of 30 seconds. There was minimal pain until the very end of the stent came out. That was a 7 on pain scale of 1-10. I have had a little bit of cramping feeling in my side and back but besides that it feels so much better to have that thing out of me! I haven’t taken any pain medication for the cramping because it hasn’t been too bad.
    In my opinion, the initial recovery from the ureteroscopy was much more painful. I couldn’t even get out of bed for 2 days and the constant feeling of having a full bladder but not being able to get rid of that sensation no matter how many times I went to the bathroom was horrible. The over the counter med AZO was a miracle drug! It helped a lot!

  16. Nikolas says:

    i am gonna have the stent removed in a few days and i need to know if they are gonna place a catheter afterwards as they did when they inserted the stent?!

  17. Walt says:

    I had a stent removed today with a cystoscope in the office and the anticipation was much worse than the procedure. I was terrified. It turned out not to be much worse than getting an IV put in.
    The nurse cleaned my penis and put some numbing tell in. This is an uncomfortable burning pressure but I didn’t think she put enough in. After about ten minutes the doctor started, and the stent was out in about thirty seconds. There was some pain when the scope pushed into the bladder and when the stent started out, but not extreme and only for a second. Very slight discomfort when urinating afterwards, but not much.
    I would have it done this way again, especially if the same doctor did it.
    If you’re not happy with your doctor, try another.

  18. Linda says:

    I have had a stent since June 24, 2015. I was rushed to hospital on the Island via ambulance as I have only one kidney and it was blocked by a kidney stone. I had only 7% function. The urologist who did the surgery was wonderful as I didn’t feel the stent at all except for some back pain. The stent was removed yesterday, July 29, 2015. After reading all the above comments I was scared of the procedure. The pain was like having a pap test and having a catheter pulled out which only lasted a few minutes. There was no bleeding after or nausea. It did burn a couple of times after I emptied my bladder. Today I have my appetite and energy back. I hope everyone who has this done has a great urologist like the one I had.

  19. Ashtyn says:

    I had PUJ obstruction on my left kidney. I had day surgery in March 2015 where the urologist put a stent in the kidney. When I woke in the recovery room I felt extreme pain and the doctors said I just have discomfort from the stent. The pain team and my nurse who where phenomenal sat by my bed and tried to control my pain. I am only 16 yrs old (15 at the time of surgery) and everyone told my mother that I was fine (she obviously was not aloud in recovery). The truth is that I was on 3 times the amount of adult pain killers and the pain was still horrible. I remember thinking that I was going to die. I went through this pain for 4 hours until they removed the stent. After surgery the nurse told me that they were lucky they removed it “immediately” because I was under so much pain and my body started shutting down they thought I would die.

    Then in on July 16th 2015, I went to Brisbane to have a laparoscopic pyeoplasty. This surgery went great and now my kidney is functioning as it should. One thing that frustrated me most about my condition is that I went to the emergency room several times and every single doctor said that they don’t know what to do.

    The chief doctor or whatever told me that I was just being a sook and probably depressed and that’s why I have the pain. He came into the room and told me that I was just missing my boyfriend. So I told him that I don’t need men to fill my life. I am extremely angry that he treated me this way and dismissed my case telling me nothing was wrong. Idiotic doctors should get away with this kind of stuff and know that you can report them. The process is long but I am in the middle of it now.

    Moral of the story: Don’t trust one doctors opinion because you could have a serious medical problem.

    • Kate says:

      I live right next to two hospitals. I went to one hospital consistently for kidney pain over the summer. Everytime even though I explained that I have chronic stones they never tested for them. I went to the other hospital late September and they tested me immediately. I was told to call the urologist and get an appointment ASAP. Well my surgery was scheduled for the 15th if october I ended up going in due to severe pain. I had my surgery moved up to the next day. I had surgery to remove a 14 mm stone that was obstructing October 12th. Here its is November 10th and I’m getting my Stent out.

  20. lisahollis says:

    How long should a steint be in ,and if bleeding occors,while steint is in what do u do .thank u this has been very interresting,andenjoyed the viedos and understand the process of putting one in and taking one out alot better my son is going thur this removeal process today.sinserlly,yours,lisahollis

  21. Max Lecaros says:

    A urologist lied to my mother and stated she was dying. He also lied and said her white blood cells where high which they were not. My mom had a very strong pain in her back and stomach area and I’m sure she could of been cured with medication and rest. She had a 5mm kidney stone showing in the cat scan from the emergency room when she called 911 because of her pain. We went to go see a urologist 2 days later and the urologist rushed her back to the emergency room to set her up for surgery the same day he saw her. This doctor almost killed my mother. When mom was seen first in the emergency room when she called 911 they did blood work and her platelet levels were normal. 250,000. her white blood cells were perfect. When we went to go see the urologist 2 days later he lied and said her white blood cells were high and that she is dying after seeing her for one minute. Please help us he almost killed my mother. Her platelets dropped to 14000 and white blood cells rose to 18,000. He butchered my mother inside infecting her blood and almost killing her. Urologist’s like him should loose their license so they stop hurting and harming people. Urologists should take the time to do the best for the patient and destroying a person’s inside for no reason should be punished by law. Please help us. My mother still has the stent inside her kidney and I don’t want my mother dead because of a ruthless urologist who should be in jail. If feasible please contact me at my email so we are not lied again and we do what is best for my mother’s health. The day of surgery mom was sent to icu for 3 days and than 3 more days at the clinic. The urologist stopped by the last day and suggested my mother stay their as she slowly got worse. We went home day five after good doctor from the hospital in Florida(blood doctor) said mom could go home. I’m taking good care of her now and she is recovering slowly but surely with the healthy foods she always enjoys to eat. Unfortunately, she still has the stint inside of her and we don’t know what to do. We surely don’t want to give this ruthless urologist another chance to kill her. Please help. There are criminal doctors out there and they should be put away before it is to late.

    • Mike says:

      You need to help yourself. It happened to you. You should see a lawyer probably.

    • Bunny says:

      You should always find a doctor that you trust! Find another urologist for a second opinion and stent removal eventually. And get a copy of the records showing the drastic change in status in just a few days and you might have a negligence (malpractice) claim that an attorney might want to pursue.

  22. Elizabeth says:

    I recently had biopsies of bladder & stints put in. I was really looking forward to my urologist removing the stints after 3 days of horrible pain which wasn’t being controlled with Toradal. The stints were removed in his office, I had no pain, but about 5 mins later enroute home in our vehicle, the pain started & soon after, the vomiting, took a rectal gravol so I could hold down the painpills, I took 2 ESTylenol as well, phoned urologist, left messages to mo avail, until next am from his secretary, who said ‘I’ll take note”. Long story short, pain was controlled for 6 hrs, then 2 hrs of HORRIBLE pain, 12/10 until following early am, pain was just getting controlled, I suffered an M I bcs my BP was so high from the stress “coronary spasm”, spent the next week in ICU, still recovering, lucky my heart has no damage. My kidneys bled+++, creatine levels rose bcs. Of beng put on blood thinners for MI.
    Grateful to be alive, trying to cope with my anxiety from this extremely traumatic experimce.
    Get drugs that control your pain BEFORE you even have the surgery, get a urologist that is available.
    Would I do this again? NEVER

  23. Elizabeth says:

    I recently had biopsies of bladder & stints put in. I was really looking forward to my urologist removing the stints after 3 days of horrible pain which wasn’t being controlled with Toradal. The stints were removed in his office, I had no pain, but about 5 mins later enroute home in our vehicle, the pain started & soon after, the vomiting, took a rectal gravol so I could hold down the painpills, I took 2 ESTylenol as well, phoned urologist, left messages to mo avail, until next am from his secretary, who said ‘I’ll take note”. Long story short, pain was controlled for 6 hrs, then 2 hrs of HORRIBLE pain, 12/10 until following early am, pain was just getting controlled, I suffered an M I bcs my BP was so high from the stress “coronary spasm”, spent the next week in ICU, still recovering, lucky my heart has no damage. My kidneys bled+++, creatine levels rose bcs. Of beng put on blood thinners for MI.
    Grateful to be alive, trying to cope with my anxiety from this extremely traumatic experimce.
    Get drugs that control your pain BEFORE you even have the surgery, get a urologist that is available.
    Would I do this again? NEVER

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