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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521 Responses to How is a ureteral stent removed?

  1. Joel DeClue Sr. says:

    Regarding Stents – Put your feet up, let me tell you a story my fellow kidneystoners brothers and sisters :)

    I have had 100’s of stones, 25+ ESWL’s and probably around 15 stents placed as well, all over the last 28 years. I am lucky in that I can tolerate a stent pretty well, yes it hurts if I bend to much, I do get an urgency to urinate frequently but severe pain only occurs in short bursts when actually urinating. I have found if I sit down, lean back a bit to straighten my urethra and the stent as much as possible, take deep breaths and relax ( as much as possible) it lessens the pain from severe to tolerable. Of course us kidneystoners have a different painscale then the typical 1-10, smiling to unhappy face that most people are used to. Ours goes to 11!

    The first stent had a string attached, in 1989, my Urologist actually tied surgical thread to the bottom through one of the drainage holes as this was prior to stents having threads attached. He was still unable to remove it, with the string as it kept catching on the inside of my bladder, so I had to go under general anesthesia to have it removed. Since that time I have never been able to have a stent removed without being put under, not for lack of effort. Multiple times Urologists have tried but stopped immediately after a minute or two of trying and scheduled a cysto with general anesthesia.

    The last time it was tried in an office, the Urologist, who placed the stent and did a ESWL (this Urologist shall henceforth be called he whom shall go unnamed) and his nurse were in the room. He whom shall go unnamed numbed me up and then went in with the cysto. After approximately 20-25 minutes of being yelled at by he whom shall go unnamed to just relax, over and over and over again, passing out from pain once and his nurse breaking into tears, screaming at the doctor to stop and then leaving the room he whom shall go unnamed finally gave up after blaming me for the failed procedure. I then promptly threw up from the pain and it took another 30 minutes before I could get of the table and the nurse helped me dress, all the while she was crying and apologizing to me. His partner removed it the following day at a day Surgery Center under anesthesia. Took almost a week to get over the pain in my urethra and bladder from that initial attempt. Never heard from or saw he whom shall go unnamed, nor did I even recieve a bill or anything regarding that office visit, no documentation whatsoever, odd. So, I found a new Urologist right away for the next few years, wonderful man, still practing but doesn’t take my latest insurance, bummer. If you are in the Reston, VA area, and in need, add him to your list to check out, Dr. Daniel Laurent. Hope it is ok to name a Dr here.

    So why the big deal with getting these stents removed? I just found out!

    Enter my latest Urologist, good guy like all of my Urologists, except he who shall not be named. So I explained that I have never successfully had a stent removed without anesthesia. I have had about 8 Urologists over the last 28 years as I moved multiple times up the east coast. 3 weeks ago I had an ESWL performed on my left kidney to break up two 6-8mm stones, no stent. Yesterday I had a cysto performed to check my urethra and bladder, I requested it becuase I have been having some minor issues and a prostate check did not explain them, that was followed by another ESWL to break up 3 stones in my right kidney. Since I have successfully passed 8mm stones in the past we decided that no stent was needed for either.

    Turns out that my Bladder is rotated backwards by quite a few degrees from normal. Appears almost normal on x-rays etc., but the angle to get the cysto to my ureters was extreme. Just like my kidneys, which are also rotated so that the tops face outward from my spine and the lower poles face inward, about 35 degrees from normal, the lower poles do not drain properly, hence 100’s of kidney stones despite massive fluid intake and activity.

    Anyway, due to the rotation the cysto device has to be tilted at an extreme angle to get to my ureters and the reason the doctor who shall not be named was unable to get to the end of the stent to grab it. Yeah, just relax, hah you try that when the device is at such an angle he is butting it up against my leg!

    So, after only 28 years, countless x-rays, placed and removed stents, etc. I finally have an answer as to why a Urologist has never succeeded in removing a stent without anesthesia! Well it’s that or I just need to relax more 😉

  2. Gary says:

    I just had surgery to remove a Large Kidney Stone that was attached to my Kidney and Ureter the Stone was there for over Ten Years and scar tissue built up around the Stone The first Surgery didn’t remove the Stone I had a Stent placed in after the First Surgery then 2 weeks later I had the second surgery which was successful I have a Large Stent with a String well taped must keep it in for a Week then will remove it myself. It is uncomfortable a little painful but looking forward to removing it in Five Days. My Stone measured 2.7CM

  3. zaki says:

    I have 15 mm stone finished opration doctor his put me in side sten i want to know remove sten after coming something problem

  4. James says:

    Had my stent removed yesterday in Dr office. They squeezed a tube of lidocaine jelly in my urethra…then doc went in to grab stent. I don’t know if it was pain…but the whole procedure was the most uncomfortable thing I’ve ever been through. Today no pain…clear urine…ordeal over

  5. Jason says:

    Stents with a string are barbaric. Plain and simple. The string snags on clothes and in men, spontaneous nocturnal erections can be a nightmare.

    • Robert Hill says:

      You aren’t kidding. Found this out last night. For some reason my doctor left the damn strings nine or ten inches long. They get all discumboobulated while sleeping. And when it hardens, if the strings are not straight out from it, ouch! Stinging as the string pulls on the upper or lower urethra. Since the article says that they sometimes go in after the strings, I might just cut mine. The hell with it. If they were only two or three inches long they’d be easier to deal with.

  6. Chet says:

    I had kidney stone surgery yesterday. They sent me home with a string attached to a stent. After waking up this morning the string is gone. Should I wait until Monday to go to the doctors office or should I go to the ER today? I just do not know if there is any danger with the string going back up into me.

  7. santhosh k a says:

    Sir,I am 32 year old men and I have stone@4mm.now the st end is inside my body.if the st end is not removed from my body any problem faced in future

  8. I am a 52 year old woman. I had a 4 mm kidney stone that blocked my uterer I had surgery on August 19 to have it removed and a stent put in. I developed sepis and had a resistance to antibiotics. They finally started treat me with a med to keep memo patients from getting infection. The stent was very painful yes but I found with 600 mg of ibprophen and Tylenol 3 every 6 hours and not doing anything to strain my stomach made it a lot easier to deal with. Yesterday September 15 I had my stent removed. I simply took 600 mg of ibprophen to keep from swelling and I felt no pain just a little pinch when the stent come out. When I got home I took my Tylenol 3 got plenty of rest not using my stomach muscles and I’m doing fine. I also have a very low tolorance for pain but I’ve been able to deal with it. I hope this can help others the way its helped me! Good luck to all! May God Bless

  9. Debo says:

    First, I have the best doctor I have ever had, met or even heard of. He is amazing. The office is closed right now, so here I am. I had a double j stent put in for two weeks. I was nervous, but after reading many forums, it seemed the concensus was it was quick and painless. I had it removed today at 3. I have a low tolerance for pain and can I tell you it didn’t hurt a single bit!!! It was quick and painless. Heck a obgyn exam is more uncomfortable than that this. I felt nearly immediate relief from all the issues that the stent had caused. I was shocked, it wasn’t even uncomfortable and the relief of having that thing in me for two weeks was glorious! Well…..I was fine for the first couple of hours. But now I am feeling pain like the day they put it in :(. I was told this will pass- did anyone else experience pain after the stent was removed and for how long? Any advice?

    • I also had a stent removed sept. 15 it was wonderful getting it out. Then a few hours later I had bad cramps and pain in my back. I’ve been taking 600 mg off ibprophen and a Tylenol 3 every 6 hours and am having very minimal pain. I’ve also been doing nothing to use my stomach muscles no bending or pushing now I’m feeling fine and its been 24 hours or less. Once you get the swelling down in your kidney and utherer you’ll feel a lot better. Good luck!

  10. Sharif says:

    I had stone in my kidney 9mm , which blocked my ureter. Now dr put stent so now after a month he has to remove but there is no string !!
    So how will he remove it without anestesia

  11. Kathy says:

    Hi,
    So on Aug 24, I went to the ER with severe pain in the left side and flank, which caused me to vomit. They gave me toradol by IV and sent me home, with an ultra sound scheduled for the next day. During the Ultra sound they discovered a 1 cm stone which was too large to pass and needed to be surgically blasted. I had this done on Aug 31, and the stent removed yesterday, sept 7 by the urologist. I like most of you was very worried about both procedures. Let me start by saying, the blasting and stent procedure is ok, I was out completely. However was not able to return to work the next day like they said I would. I had pain for about 3 days after, and then it was more annoying than anything due to the feeling of the stent. I had pressure under my rib cage and pain like a splash back in my flank when I had to pee. I did not have the sensation of having to pee all the time as most others do, but I had a burning when I had to pee. Stent removal was fine, yesterday sept 7. Pain was about a 1, it was the nerves and not knowing what to expect that was killer! But the process was fine. HOWEVER….2 hrs after the removal, I felt pain like I did prior to the surgery…! Felt like I was passing a stone. Thankfully I had Toradol and t3s to help, but it was awful. Then about 10 hrs later I started to bleed. I couldn’t tell if it was my period starting early or from the procedure. I called the urologist and they said both the pain and the bleeding are Normal, and should dissipate over the next couple of days. Why were these side affects never told to me??? Has this ever happened to anyone else? Why did the urologist not perscribe pain Meds. The Meds I had were from the ER doc! And the urologist would not write a doctors note to be off work…had to get that from the family doc! So not impressed with the lack of information regarding this whole process. I am a mother of 2 and would gladly have a third before having kidney stone pain again!

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