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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573 Responses to How is a ureteral stent removed?

  1. Joe Hermann says:

    Went to get stent removed from my kidney yesterday after it was in 3 weeks however it broke off inside me during removal. Now I am told they will go into my back and try to remove remainder (about 5 in) of the stent that way.
    Surgeon said this is a first for him!!! Not good for me!
    Anyone have experience with this type of issue??

  2. Javid Nisar says:

    I have got my stent removed one hour ago and its bleeding a lot. I’m scared!

    • John says:

      I got my stent put in this yesterday. The Dr told me that excessive bleeding is normal. It should start turning a brown after a day and it should clear up in a couple of days. Mine has the string and I’m so tempted to pull it out its so uncomfortable

    • John says:

      Cancel that last reply. I replied on the wrong thread

  3. Robert marsh says:

    Went back to hospital on 12th May to have stent removed, but after they had tested my water sample it was found that I had a bladder infection. So they wouldn’t take the stent out then. They have given me antibiotics which i have to take for 14 days. So hopefully the infection will have gone by then and if so the stent can then be removed.

    • Robert Marsh says:

      I’me afraid that my previous report about my stent removal has proved to be incorrect. i was under the impression that they had done the removal, under local anesthetic but that wasn’t the case. They couldn’t retrieve it and they have since told me they will now have another attempt on the 22nd June , this time performing the procedure under general anaesthetic. Since the first attempt I have experienced a great deal of discomfort, passing blood, needing ‘to go’ very often, and very uncomfortable feelings and soreness in the pit if my stomach and groin area. All of which I could do without ! Roll on the 22nd and hopefully the beginning of the end of my complaint

  4. Robert marsh says:

    Went back to hospital 12th May to have the stent removed but after they had checked my water sample, it was confirmed that I had a bladder infection. So as a result they informed me that they wouldn’t remove the stent then, they have given me antibiotic tablets which I have to take for the next two weeks. They will then review the situation and hopefully if no more infection the stent will be removed.

  5. Robert marsh says:

    Not very comfortable but a relatively minor op, afterwards it was well worth it

  6. Monica says:

    My husband has a stent for one years do you thing that is normal

    • Buffy says:

      I had a stent put in yesterday. After 4 unsuccessful surgeries, they finally got them all!! My question is do you know if your Husband had extreme pain when urinating and very frequently urination? Ty. Buffy in Augusta Maine.

  7. H. J. Janse Van Rensburg says:

    Hi,a couple days ago me and my wife went to bed and at about 2am in the early morning I was getting this very sharp pain on my left bowl. As I did not know what was wrong with me ,I sat on the toilet but nothing happened and the pain got worse and I started vomiting badly. My wife drove me to hospital and the nursing staff put me on intravenis medicyn and drips.A sonar scan reveales that there was a small stone in my renal tube and three large stones still inside my left kidney.The size is about 5mm to 7mm.I just came out of hospital this afternoon and have to go on the 19th of may for Endoscopic removal of left ureteric stone and left renal stones. I am quit scarred and don’t know what I can expect.

    • Robert Marsh says:

      On the 4th may 2017 i had kidney stones removed from my right kidney at Manchester university hospital in Manchester England. This is a National Health Service hospital. I would like to assure you that the procedure was done under a general anesthetic and no discomfort was felt at all. In fact the anesthetic worked immediately and I found myself in the recovery room, quite amazing. The surgeon informed me that I had a stent inserted in the uretha to help drain the seppage that might occur. I now have to go back to the hospital on Friday 12 May to have the stent removed , this being done under local anaesthetic. I am informed that the removal takes only a few seconds and within a very short time after life returns to normal. I am 81 years of age , but feel like 21 . Finally how wonderful it is to have a National Health Service like ours, no insurance cover needed ! I hope this will give you some peace of mind and I wish you good health in the future.

  8. im surgon says he put have mental half plastic stint in my vilduct to remove gallstone that lodged in my vilduct after a gallbladder removel he says i pooped it out is that even sound right im very sick everday since i feel like im going to die he also lied and told me he put plastic stint in and nothing eles but the anistiogeles when i woke up from surgery said he put mental stint in can someone give me information abount stint and if they ever come out i think this doctor tryed to kill me

  9. Ernest says:

    When the stent if removed is it supposed to have a chunk of meat on it my doc said it was fine. But didn’t numb it or anything just yanked and this dime sized piece of meat came out with the stent is that normal

  10. Lucy says:

    An attempt was made to remove my 4mm kidney stone, and failed. I will need to have the surgery again in two weeks, and until then will need to keep the stent. It is very uncomfortable, and I’ve been taking the drugs that have been given to me. I hate taking them, and am going to call my DR and ask if the stent can be removed until the next surgery. I had no idea that the surgery wouldn’t be successful, and am going to do everything in my power to never have this happen again!

  11. 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.

    • Chris Cockrel says:

      I just got mine removed there is some discomfort the main thing is to above everything is to stay relaxed and take deep breaths until the procedure is over. But I must say after it is over I felt a lot better even going to the bathroom there is no discomfort now . I wish you good luck.

      • Sami says:

        I agree. Relax. Even though that sounds crazy considering the process. Best thing you can do is relax.

  12. 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.

    • Jack Abbott says:

      Just had a large one removed and go back five days to remove the stent . After I read your comment , I realize that even though I found the pain devastating, it was nothing compared to your experience . I know very little about the pain you have had to endure but my mind will.go back to what I read and my prayers are with you . I am not totally sure of how some old and very weak patients are even able to endure this procedure. You may be alone in person but you can know that there are those.of us out here that empathize with you .

    • Rose says:

      Research jonbaron.com and research the herbs: Chanca Piedra and Uva Ursri. They help with reducing the size of kidney stones and inflammation without surgery.

  13. 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

  14. 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.

  15. Dan Bassett says:

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

  16. 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

  17. 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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