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 www.KidneyStoners.org website.
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554 Responses to How is a ureteral stent removed?

  1. amanda williams says:

    wow..ive had 2 stents in my left kidney for 3 months now..i go may 1st to get them removed…im scared what the pain may feel like. dr said he would put numb stuff down there and pull it out.

  2. Shirley Green says:

    hi every one id like to share my experience of a stent and stones. 2 years ago i was diagnosed with Diabetes tablet and diet . un knowing to me when i was diagnosed with 2 very painful stones my blood count stood at 136. i live on my own lay there for 3 days not eating thinking i just had a water infection but on admission to hospital 26th November 2016 was told i had stones. 2 days later on the monday i was taken down for a stent. i begged for pain killers when i came round and was given them regular 2 days later i felt worse and after an x ray was told the stent was in the wrong place so it was pulled out. then radiology put a drain in my back through my kidney which was very uncomfortable. i was left with a tube in my back and bag for my urine to carry round.altogether i was in hospital for 13 days. now we are in April 2017 ive been off work all this time at first i felt ok. i was told i couldnt have stent out till my blood count came down as i couldnt have an anestetic as it was dangerous all i had very loose tooth and i had to have that taken out before they can put me under anistetic. i had my tooth out at the cost of 230 pound and small denture made. im on my 3rd box of pain killers as i cant move without them. approached my doctor and hospital crying with pain. they say just that my bloods need sorting even though they done the op in an emergency in the first place with my bloods so high and very loose tooth.im depressed very much in pain hurt every day when i go the toilet i wouldnt leave a dog in this much pain.i have 2 stones both lodged one in the kidney which has embedded itself in and the other in my tube. consultant says when im finally well enough to get the opp the will put camera in remove one stone then replace the next stent for 7 to 10 days then go in to remove the stone in my kidney. the pain has been unbearable i cant walk hardly. constantly taking pain killers and hot water bottle. wouldnt wish this on my worse enermy. so end of April i have another blood test get the results 8 th May see what they say that will be 6 months off work. im so depressed its unbelievable so watch this space. i wouldnt of been this ill if theyd of opened me up and took the kidney out. sorry so fed up needed to rant.

  3. Sara anders says:

    I am having my kidney/bladder stent removed Friday. This article helped my anxiety toward the removal. I had a tumor growing on my kidney outflow tube so a stent was placed to keep kidney function. I can’t wait to urinate normal. Thanks for the info

  4. Mrsaugust74@gmail.com says:

    Getting my kidney/bladder stent put Friday. This article makes me feel less anxiety for removal. I had a tumor growing around my kidney outflow tube so a stent was inserted during chemo to help kidney function. I can’t wait to get it out and hopefully get back to normal urination.

  5. Dan Bassett says:

    If I was you I would do whatever I could and get yourself to a better hospital

  6. Akash says:

    I had a 1.2 cm stone in upper left urethra. A stent was placed and even after 4 sessions of lithio(eswl) a small fragment remained. It finally came out after 5th session, after 2 months of discomfort confusion​ and pain. Getting the stent removed next Saturday

  7. Crystal says:

    I had a Stent placed in my left kidney in early Jan. I only found out I had kidney stones in December when I collapsed in a shopping centre. The Stent placing was traumatizing and I can’t even begin to explain the pain, a bit of lidocaine jelly, and they might as well have kept that jelly. The pain is beyond anything I could ever explain. I nearly got sick right there on the table, and I still needed to drive myself home.
    When my mother saw me when I arrived home she just looked at me and said “good lord Crystal, what have they done to you”. Got straight into bed and tried to sleep, but you can’t sleep through that kind of pain. My mother found me sitting on the toilet that night with a blanket around me, a pillow leaning against the wall. It’s April now and I still have the Stent. I work for myself, and literally list my business because I couldn’t work, I’m a driving instructor. I have had infection after infection, after infection, had septicemia. If my son didn’t come through to visit me I would have died. I’ve had the shock wave treatment to shatter 6 stones ranging from 2.1 down to. 9cm. The Stent infections have been beyond pain levels I can explain, I’ve been hospitalized twice for sepsis, I basically lost my driving school business because I could work, I would pass out from pain and fever during lessons, or just pee in my pants in front of the students because I had no control over my bladder. I’ve been on so many antibiotics and pain meds over the last few months, it’s actually not funny. My urine smells so bad, I want to run away as soon as I have weed. Went for another check up, because I want this Stent out, but the scan showed up that I still have 1.4 and 1cm stone in my kidney, and a whole lot of stones has attached themselves to the Stent. I’m only due for another sell 1 June, I don’t know how I am going to manage till them. When I asked the dr for pain meds and antibiotics, he plainly refused, said I’ve already had too many pain meds and antibiotics. A few weeks ago while really ill very high temp I had to drive to the chemist and ended up wetting myself while waiting to pay, so humiliating, and then I crashed my car. Since December I have hardly worked because of the constant pain and fevers, and also not wanting to embarrass myself with students if I wet myself again. I have been able to cover rent, pay off any dr’s and I owe them about 20k already. I have never in my life been so ill. The content pain of the Stent, the pain when urinating and just a general feeling of being yuk. After this I never want to see a urologist or a hospital ever again. When I hear that the Stent is going to be burned I will be there, it is the most excruciatingly pain, it’s barbaric to do it with being sedated, I’m scared for life. I have to drag my body through work every day as I’m always feeling so darn frikkin sick.
    The hospital I attend is a government hospital, and the nursing staff are disgusting. You can be dying and they will walk straight over you, I lay on a trolley for no mattress for 4 days, the room was for 4 beds, we had 8 jammed in there, the only time you saw a nurse was when your chart needed to be filled in. Linen in the 4 days was never changed, not once was someone there to sweep or mop, the lady next to me was bedridden and she needed to be turned every hour, eventually we as the patients would turn her. My catherter bag didn’t have a stand, so when I showered I had to hold the bag in hand, not once did a nurse come empty the bag, I had to do that myself, when my drip came loose, instead of fixing it, it was just taken down. I am scared for life.
    And to think I still need to go through this until June and beyond. When I had to go to the triage as my temp was dangerously high, the dr wanted to admit me, but I made him promise before I even got there that he wouldn’t, I just told him I can take better care of myself, and if I go back to those words I will die of another serious disease.
    A very, very tired and reluctant Stent carrier. I hate government hospitals, I hate kidney stones and I hate incompetent nurses and I hate stents. If I had a string it would have been out already. I honesty can’t bear the pain, and it’s taking me so long to rebuild my business again. Due to not working for 3 months, rent has been paid, and I owe the hospital over 20k. I’m so ucking mad tired already. #thestentmustfall

    • Lauren says:

      Where the hell are you??? The sheer lack of compassion and understanding from the hospital is staggering. I’d like to help.

    • Ginny says:

      Wow Crystal, I am so sorry for what you are going through. I can’t even imagine having a stent placed while conscious. In fact I’ve never even heard of that. I was afraid of having my stent removed as normal procedure for removal is while you are conscious but it was a breeze. One little pinch and it was out. We all hate stones and stents. Be sure and ask what your stones are made of. I’m sure you want to avoid future stones. There are like 16 different type of stones so you see how important it is to analyze the stones. I had to push the surgeon to do this. Of course they don’t care about prevention. It’s not them with the stones and more stones equal more business for them. Just want you to know that I am praying for you now.

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