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.
This entry was posted in Information and tagged , . Bookmark the permalink.

475 Responses to How is a ureteral stent removed?

  1. Tsitsi chikonyora says:

    I had my ureterel stent a week ago. I am experiencing severe pain everyday. Is that normal and how csn it be solved.

  2. Brian says:

    Is having the stent worse than a catheter?

  3. Bobbie S says:

    I had a stent put in on July 9th and don’t get it removed until July 27th. I don’t have a severe pain that people have said they have had. Mine is more annoying. I do have a very high pain tolerance. Pretty sure that is from growing up with 2 older brothers and me being the baby sister in the family. I just hate having the feeling like I need to pee all the time and not able to get all of it out. My urologist didn’t leave a string attached to my stent. I am nervous about the removal process. Has anyone else got theirs removed in the office? How was the process done for you?

  4. Rickie says:

    I am having my stent out on Wednesday , today is Monday. I Dont really know what to do to ready myself, I just pray that after the removal of the stent that I can pee without the burning and pain.

  5. Adelaide Simpson says:

    Why domwe need stents? I have no stones, the Dr. Is removing the stent next Wed..She wants to replace it , I do not understand why I have to, have another one incerted.
    does anyone have this problem?

  6. Jake says:

    I am a regular “stoner”, and I have had stent removals by the Doctor and for the first time today, by myself. The hot tub for 15 minutes with some relaxing tunes is the absolute way to go. The “anestehsia” at the Dr’s office is a topical and is a joke. The hot tub gets you relaxed to the point where you can just perform a slow steady pull and voila, it’s out.

  7. susan betts says:

    I have had a stent left in since may 9 weeks I’m in agony..i have a small cushion which I have had between my legs none stop. The pain is unbearable.stomach feels full all the time.hats off to people who still go to work, incoulnt leave my bed. My daughters looked after me all the time.putting up with me crying all time.I’ve had a letter that there going to remove the stent this Tuesday.I want it out but scared to death.

    • Josh says:

      I feel your pain Susan, a hot water bottle on the side where the stent is works wonders, I’ve managed to get hold of some co-codamol through a friend too, both are a godsend.

  8. Ed says:

    I recently had a stent put in and it was uncomfortable for the five days. I asked my doctor how was the sent going to be removed. He said I Could pull it out myself or come into the office and he would. I spoke with a friend who has had stents put in four or five times. He told me to get into a hot tube of water for about 15 to 20 minutes to let my body relax. He said then have my wife pull it out and it will not hurt.

    So I cancelled my doctors appointment and got into a hot tube of water and relaxed. Then I had my wife come in and she pulled the sting at steady pace without stopping until the tube came out. I had absolutely “NO PAIN”. The tube of hot water is the way to go.

  9. Amber says:

    I have a sent as of now it is time for me to take it out can i set in the tub or it has to done in the shower

  10. Jacqueline says:

    25 year old female here and on my 3rd stone. I passed the first two, but this one got surgical intervention to break it up. Stent is in place on the right side. Thank God I was given antibiotics and percocet. Not sure what I would do without these pain meds.

    Keeping a heating pad behind my back and between my legs really helps dull the pain too. Trying to take it easy and not accidentally pull the string.

    Not sure if I’ll be able to make it into work on Monday. Removal is on Wednesday, but the discomfort and pain is enough to make concentration almost impossible. Pretty sure I’m running a low grade fever, but they said not to be concerned until it’s 104.

    Drinking plenty of water to try and keep hydrated and flush out the kidney. Feel like I gotta pee 24/7, but pushing on the bladder let’s me know if I actually do (same thing happens when I get a stone). No matter how much water I drink, I still have blood in my urine, but I’m hoping that clears up in a day or two? Peeing was almost unbearably painful, but the pain seems to be letting up soon. I try to keep my pee breaks lined up for soon after I take a pain pills. Sucks that Peeing takes forever, cause it takes a while to empty the bladder.

    Here’s hoping the stent removal goes well. Not sure what to expect, but I hope they give me something good before starting haha

    • Kristen says:

      Omg! I have stones and had a stent placed today! I’m in so much pain! Urinating is very painful and feels like razor blades!

Leave a Reply

Your email address will not be published. Required fields are marked *