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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294 Responses to How is a ureteral stent removed?

  1. Dan Hill says:

    Thanks for the info on stent removal. I had Ureteroscopy surgery yesterday. They used a laser to break up an remove the stone. I have been through the “peeing razor blades” ordeal, but on day two, things are improving. Looking forward to having the stent removed. I am going into my urologist’s office at the end of the week and he will pull it out. It’s good to know what to expect.

    • Steve L says:

      I just had one removed today. Contrary to this bogus article, it took 4-5 minutes. The pain as he was going through my prostate to get to the bladder was terrifying. Good luck!

  2. shijow basumatary says:

    i had my dj stent for almost 9 month. my question is what is the out come of having dj stent for so long time

  3. Jerry says:

    I had a stone diagnosed in July of 2014 after seeing blood in my urine. They did a CT scan in the ER and saw the 6mm stone in my kidney. Later I went to the Urologist and he said I could just leave it since it wasn’t causing any pain, or they could surgically remove it with a scope and tiny laser. Since another condition that results in blood in the urine is bladder cancer, the doc suggested they do a cystoscopy and scope my bladder to make sure I was clear. After months of sleepless nights worrying about 1) when the stone would come and I would experience the horrible pain, and 2) if I had bladder cancer; I finally scheduled the stone removal and scope. The doc gave me a clonazapam (aka Klonopin) for anxiety to take before the procedure which was wonderful for reducing my anxiety. The surgery went well, I was put under general anesthesia so I didn’t feel any pain at all. He informed me immediately after the procedure that I don’t have bladder cancer (amen). Then he left a stent in for two weeks.
    Having the stent in was not too bad, I just felt like I had to pee all the time, and took flowmax which did make me pee all the time. It hurt when I pee for the first few days, but that got considerably better over time. I tried to exercise on a treadmill but that was a bad idea, the more movement the more the stent irritated my bladder and increased the feeling of having to pee. Best to keep movement to a minimum with a stent in.
    Again I was stressed about the removal of the stent, which was to be done via cystoscopy in the doctors office, while I was awake. Again the doc gave me Klonopin to take before the procedure. They put the anesthetic gel into my penis, which I was worried was going to feel like a shot, but actually didn’t hurt at all. It just felt a little funny, but zero pain. They let that work for about 10 minutes, and then they went in with the scope to remove the stent. It was mildly uncomfortable, but maybe only a 2 or 3 on the 1-10 pain scale, and it took no more than a minute for the doc to grasp the stent and pull everything out. Again, it was not very painful at all, just a weird feeling like pulling a piece of spaghetti through your nose when you were a kid. It hurt when I peed again for the rest of the day, but in the morning nothing at all. Today is that morning and I feel great. I just wanted to share my story because I was worried sick about the whole thing for months, but the reality of it was that it was no big deal. This is a routine procedure for a qualified urologist, and it was no worse than getting a filling at the dentist. Good luck to everyone. My doctor was Roger Sur at UCSD in San Diego, I would recommend him if your doctor isn’t working for you. Good bye and God Bless. I hope I never need to come to this site again :)

    • Tom says:

      Jerry,

      I am going in tomorrow for the stent removal proceedure and have been feeling anxious about it for days. Thanks for the info. I feel much better about it already. But if you are wrong about the pain I will hunt you down–lol–just kidding. Thanks again for sharing. I had a failed kidney stone removal on Dec 8 but they did manage to get a stent in to drain the kidney. But they wanted it to heal up so they left the stent in for three weeks until the next surgery to remove the stone. That surgery was successful but they wanted to leave the stent in three more weeks which due to scheduling turned into four weeks. So I have had this blasted stent in for almost two months. Sooooooooo looking forward to getting it out tomorrow. THANKS AGAIN for the info.

  4. Sir Mitch-A-Lot says:

    I’ve had four stones since September 2007. I’ve passed the first three. However, the fourth one, which was 4 mm, I couldn’t pass since finding out around last Veteran’s Day. January 13, 2015 was my surgery where I was left with a stent with the string attached. Today, six days later, I removed the stent myself roughly an hour ago. Now I’m not the one to leave any replies or comments but after reading several posts I’ve felt the need to reply. So many people, including myself, are scared about removing the stent themselves. This site, and comments from people like you, gave me the courage to self-remove. I was told to take an antibiotic pill, Ciprofloxacin, an hour prior to removal then when it’s time to stand in the shower and pull. After it’s removed I can take an anti-inflammatory (Ibuprofen) to help with any swelling within the ureter. Standing in the shower I wanted to pass out from being so darn nervous. Eventually, after like what seemed like eternity, I wrapped the string around my fingers and started to pull. I did notice a lot of urine slowly coming out. As I pulled I saw the string getting longer and longer. I kept pulling slowly and then noticed what looked like white tubing coming out. At this time I just pulled a little faster and before I knew it the whole stent was out and in my hand. After all of this, I think it only took me about 30 seconds to remove it after I started pulling. For pain, I would rate it as a level 1 or possibly 0 since there was no pain whatsoever. Just a tingling sensation as the white tubing started to exit. As I write this the only thing I feel is the feeling to urinate. Possibly from drinking 500mL (16.9 oz.) of water to take the pill. As stated, I felt the need to pass on my experience of self-removal to help others with any anxiety get through this process.

  5. I HAD A STONE THAT WAS TO LARGE TO REMOVE SO THEY PUT A STINT IN AT THE LOCAL VA IN AUGUSTA GA. THE STONE WAS DISSOLVED BY DRINKING A SYRUP MIXED WITH WATER. I WENT BACK FOR THE STINT REMOVAL IN JUNE OF 2014 AND THE DOCTOR SAID HE WAS GOING TO REMOVE IT WITHOUT PUTTING ME TO SLEEP? I ASKED HIM WHY? WHEN I WAS PUT TO SLEEP WHEN THEY PUT IT IN, AND DID THE SCOPE AT THE SAME TIME?? HE SAID AT MY AGE OF 69 THEY DID NOT LIKE TO PUT US TO SLEEP FOR FEAR WE MIGHT NOT WAKE UP!!! I WATCHED HIM REMOVE IT ON A TV SCREEN BESIDE ME USING A CREAM INSERTED INSIDE MY PENIS. HE JERKED IT OUT VERY FAST AND SWUNG IT OVER HIS HEAD. THIS ACTUALLY DID NOT HURT BUT NOW AFTER TWO WEEKS I HAVE STARTED BURNING WHEN I PEE. I WENT IN TO THE EMERGENCY ROOM AND GAVE THEM A URINE SAMPLE AND THEY SAID I HAD (NO INFECTION) I LATER WENT BACK AFTER NOT BEING ABLE TO STAND THE BURNING ANY LONGER AND GAVE ANOTHER URINE SAMPLE AND NOW I HAVE A UTI THEY SAY, A URINE CULTURE WAS ORDERED BUT NEVER DONE?? I THEN WENT BACK AND WAS GIVEN SULFUR DRUGS WHICH I FINISHED BUT AM STILL BURNING WHEN I PEE. MY PRIMARY CARE DOCTOR HAS NOW PUT ME ON AN ANTIBIOTIC CALLED LEVOFLOXACIN 250 MG TAB ONE A DAY FOR 10 DAYS. I HAVE TAKEN ALMOST ALL OF THIS BUT I AM STILL BURNING WHEN I PEE. HE ORDERED A CULTURE OF MY URINE TO BE DONE AND WILL CALL ME WITH THE RESULTS THIS WEEK. TODAY IS 1/18/2015….I GREW UP IN A MEDICAL FAMILY AS MY FATHER WAS A INTERNAL MEDICINE DOCTOR AND LATER WENT INTO PATHOLOGY. I WANT TO KNOW WHY I AM STILL BURNING AFTER ALL THIS TIME???? I HAVE NOT BEEN ABLE TO HAVE SEX WITH MY WIFE NOW FOR ALMOST A YEAR!!!

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