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 and laparoscopic surgical approaches. He sees patients patients at USC-Keck urology clinics located in Los Angeles, Pasadena, and La Canada, CA. He is the founder of the www.KidneyStoners.org website.
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226 Responses to How is a ureteral stent removed?

  1. star says:

    Hello, I have a stent in right now. Been placed in since March 27, 2014. It will be removed by doc on April 14. Two days before my birthday. Been suffering with kidney stones since 1986. 28 years. Each time a stent has been placed. This particular stone is 11mm. My stones are always huge & very painful. Doc used to put me to sleep to remove the stent. This was several years ago. Now he wants to perform it in his office. Lidocaine is used. I hate the stent bc it is soooooo painful for me. Have not returned back to work yet. I’m looking forward to having the stent removed, although I would rather be put to sleep to remove it. I just get nervous, but it does not hurt. Tired of stones & stents. ( I haven’t had a break or relief in years. Thank God for His strength that He has placed in me. I could not get through this without Him.)

  2. ken says:

    this is the second time ive had stones removed the first time I didn’t get a stint this time I had four stones removed from the right kidney all 6mm+ I will remove the stint my self so I don’t need to loose time from work hope its no big deal feel better about it after reading these posts

    • ken says:

      took my stent out today was causing pain no big deal was a little nervous but did it any way was supprised how long it was if you are thinking of removing it yourself don’t stress it was easy and painless just go slow but steady

  3. leea says:

    Omg yesterday I had the stint put in I had a stone of 2.5 cm and honestly I’ve been sick and in pain since they done it

    • Tammy says:

      I don’t know why docs can’t be honest. Had 2 ureteral stints placed in surgery. Doc says “you won’t even know they are there”. The spasm are horrid! Have to pee every 30 min which causes the spasms to start. I am supposed to pull the stents tomorrow but no one told me how. Do I pull both at same time? String is all knotted together. Have been taking pain meds, muscle relaxers, pyridium and of course antibiotic. If there are any docs ut there reading these posts, you need to be honest with your patients

  4. cathy says:

    My husband had a stent put in 25 days ago to allow for infection drainage. His stone- like on the video- is in his left kidney and was pushed back up there by the stent insertion. His doctor said that was not a bad thing to have happen. His stone is 6.8mm according to xray view. He has been taking an herbal compound called Chanca Piedra – literally, ‘broken stone’ for 14 days. I know this may sound like a witch doctor remedy but it is the ‘go to’ remedy used by patients in Brazil and elsewhere with remarkable results. I went online and read many patient reviews on Amazon and the vast,vast majority experienced breakage of large stones which then passed successfully or dissolution of small stones which passed like sand grit. The minimum treatment time for results was about 2 wks, so my husband is not expecting his results that quickly due to the size of his stone. Thankfully for him his discomfort with the stent has been mostly minor with the intermittent but short lived baseball bat in the kidney sensation when peeing. He is going to delay his lithotripsy a week at a time to allow the herbal remedy to do its job. I know if you’re in too much pain you probably can’t wait for 2 or more wks to get results, but the compound is also taken as a preventative or in the early stages of stone formation so you don’t have to suffer.

    • ken says:

      immediately upon taking chanca piedra, my pain went away completely. after a couple of weeks, an xray revealed that my 9 mm stone had moved out of my kidney and close to my bladder. the stone had not shrunk, so it was lasered.

  5. joe says:

    So I had my stent removed at my Dr.’s office via a cysto. I have to say that it was no more painful then my regular cysto checkup. Tools about 30 seconds or so and I had no spasms afterwards…. so for those that are getting them out I wouldn’t fret much about it.

  6. Bubba Jones says:

    I had my stent removed last night with the wife pulling the strings and me with a towel over my head and biting hard on it. Hurt slightly, mostly a very weird feeling with the stent moving. It was over in 20 seconds and the relief was AWESOME. I took 10 mg oxycodone and was happy I did because I had the ureter spasms for about an hour. Once I slept this off, I feel fantastic. Anxiety was much much worse than the procedure. I had panic attacks for 6 days with the stent in and am a total baby for pain. I NEVER want to get stones again.

  7. Evan Kristol says:

    Thank you all for being open about your experiences. I go to get my stint removed in about 7 hours and am a wreck. Very scared, but after reading these comments I really feel much better. I will comment after the procedure on how the pain was. Frankly, nothing could be worse than what I have gone through (5 times) with having a kidney stine. Fortunately, this is only the second stint. The first was removed while I was under anesthesia per my request. The doctor said it was a waste and not necessary. I am trusting him this time and doing it in his office. I hope it was the right decision!

    • Rita says:

      Hi, wondering how you made out? My husband James is having his removed awake on Thurs. His last one was asleep by request. Would love to hear. Thank You

  8. Cheryl says:

    I faced a different problem, my ureter burst due to complications from laparoscopy surgery. The pain from that experience was the worst I’ve ever experienced, not to mention the infection it caused, as I did not know. The burst ureter was found on thanksgiving, I was hospitalized for just about two an a half days, the day prior to finding it burst for infection and pain, the day they found out and placed a stint in to see if the ureter will heal, and the following day for more antibiotics and pain. I am grateful they sent me home with a catheter (total of five days)it helped with the blood in my urine and I believe made the process less stressful on my body, lidocaine patches, and pain meds. I am to have the stint for eight weeks, removal on the 23 of this month. I do not have a string and am apprehensive about the removal of the stint and healing process of the ureter. I will say the lidocaine patches help greatly having the stint and I do feel a lot of pain if I skip a day of the patch. My back flank pain has been increasing lately which is a new symptom, the usual pain in the area of my ureter towards my bladder (I can draw a line it travels). My main concern is the removal and possible scar tissue build up where the ureter burst, not to mention how will they know it has fully healed, will I deal with issues from now on? The closer I get to removal the more apprehensive I become; I’ve read so much on the stints and removal for stones, but not much on if the ureter burst. If anyone has had or know of someone who has experienced something similar my mind would be put at ease with this whole process.

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