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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432 Responses to How is a ureteral stent removed?

  1. KevinP says:

    I have had two 7mm stones, one in each kidney. I have to say that the stones are nothing compared to the pain of stents! I have a very high tolerance for pain, but every time I urinated it felt like someone was trying to pull my kidney out of my penis! If a “urologist” suggest a stent, find another doctor! Thanks

    • Janel says:

      It’s been my experience that those who claim to have a high pain tolerance, actually whine the most. Why don’t you try passing a stone without a stent and then you’ll know what pain is.

  2. Susan Bee says:

    I had the stent removed today. Had worried about it A lot. Honestly getting a flu shot is more painful. It took 30 seconds. Pain 2/10. (This is the first time I have ever posted.)

  3. Susan Bee says:

    I had the stent removed today. Had worried about it wuite a bit having read things online. Honestly getting a flu shot is more painful. It took 30 seconds. Pain 2/10. (This is the first time I have ever posted.)

  4. Susan Bee says:

    I had the stent removed today. Had worried about it wuite a bit having read things online. Honestly getting a flu shot is more painful. It took 30 seconds. Pain 2/10.

  5. Rich Cronkright says:

    I also had a large 9mm x 6mm stone removed a few weeks ago. The stent was not a problem other than constant bleeding especially when I did cardio at the gym. Due to the amount of laser blasting it took to break up the stone and remove it, I needed to keep the stent in for two weeks. When the doctor tried to remove the stent it would not come out. It made the journey out of the kidney but did not want to leave my bladder The grasping tool kept letting go. Slowly they got it close to being out but it still fought back. Finally after about twenty five minutes and lots of prayer, it came out. Horrible experience. Lots of bleeding for two days and painful urination like peeing razor blades. Do not wish to ever repeat this again. Put me to sleep!

  6. Madhava Rao says:

    Sr please tell me what should I do?
    I have suffering from multiple stones in both kidneys with size of 6 to 7 mm since 4 years.
    So, please give me a suggestion to get relief from this big problem.

    • Brent Star says:

      Hi Madhava, a Greek woman told me the best think to shrink and pass stones is: NATURALLY with the use of wormwood. It doesn’t taste too good but washed straight down with a cup of tea and you won’t notice at all.
      The Greek woman stood in a small metal laundry tub and peed. Many stones made a noise while they hit the tub… Amazing. I’m trying it and so far several stones have worn down.

      There are other natural remedies. Search for one.

      Brent

  7. Tony Zanussi says:

    Had a stent removed today and it was the most horrific experience this Marine Corps combat veteran ever faced! Nothing is natural about a 1/4″ thick device going up your urethra to remove a stent while you are wide awake. I had the stent put in while under anesthesia in a hospital. Why can’t we in USA (typically insured) request removal under anesthesia? If I ever get a stent again I will make sure I am under some kind of drug or alcohol shots!

    • Jennifer O says:

      I have a stent now got it last Thursday and I am in more pain than i was before. Not only are my stones 12 and 14 mm but i have ecoli for the last 8 months in my kidney and a picc line this stent is the worst pain ever i demanded they take it out so as of Friday it is coming out

  8. Sandy Estlow says:

    I had three stones removed from my left kidney on Feb. 29th. A new stent was put in after having one in for 4 months due to two postponements of the surgery. The first stent constantly made me feel like I needed to go to the bathroom and was very uncomfortable but not painful. When it was removed it had a lot of calcification on it. The new stent I can’t even feel. In fact, if I didn’t know it I wouldn’t believe I still have one in! They say they do this for about two weeks after surgery just for precautionary measures…fragments I suppose. So far no issues and tomorrow it gets removed. I’m going to have to psyche myself out for the removal after reading some of these comments. I’m hoping I’m not going to have any issues. I haven’t had to take one pain pill since having the stones removed so maybe it will be easier for me than others.

  9. Ken Sigman says:

    My wife and I had planned, and paid for, a trip to Italy for our 30th anniversary. Of course 3 days before the trip I had a large stone start to move. I went to my urologist the next day and he agreed to blast it the day before we left for our trip. 10 hours before getting on the plane, I woke up in the recovery room with an 8 inch wire coming out the end of my johnson. The Doctor told me this would let the blasted bits flow out more freely and I could remove the stent myself after a few days in Venice. While the stent itself was not uncomfortable, the fishing line rubbing against the tip made me feel like I needed to pee every 5 minutes. The 8 hour plane trip was miserable. When the water taxi let us off at St. Mark’s Square there was not a public restroom to be found and they were all pay toilets. Our hotel was only 10 minutes away by foot but needless to say I didn’t make it. At this point I was very frustrated and called my doc from my cell phone and asked him what to do. We are friends and hunting buddies so when I told him my situation he tried not to chuckle and told me to pull the stent out immediately and throw it in the canal. I did and the relief was immediate. There was some discomfort for a few days passing shards but nothing I could not handle. We had the best trip of our lives and left with this great story to tell.

  10. Paul kirby says:

    I have had issues with a large kidney stone in my right kidney and it takes months to get on the lithotripsy list so was told if I had a stent fitted it would relieve my pain till the stone was blasted. This could not be further from the truth I have had more severe pain if that is possible from the stent caused continuous bleeding major pain so much that I have ended up on three different types of pain relief and morphine and having to come off work for the first time in 11 years. I have had kidney stones for 23 years and normally cause attacks every 2 years with extreme pain but that was nothing compared to the stent. My opinion is keep well away from them if offered run and run as fast as you can.

    • Sandy Estlow says:

      I’m so sorry to hear that you suffered with pain after the stent was implanted. I had to wait two months for my surgery to get scheduled and then it was postponed twice due to a cold and then a positive urine test. It turned out the stent was giving a false reading as removing urine from the bladder showed no infection whatsoever. The stent was uncomfortable for me but caused no pain or bleeding. In fact, it was a godsend for me to get it implanted to stop the horrendous pain of the stone trying to go through my ureteral tube. After surgery I was given another stent for two weeks and this one I couldn’t even feel. I suffered no pain at all with the stent or after the surgery. Having the stent removed tomorrow so I’m hoping my luck holds out.

  11. Molly says:

    I had Litho with stent placement done last Wednesday. I had a lot of stent pain and pain with urination (kidney/bladder spasms). Today I was finally able to pull that sucker out. I took pain meds, hopped in the shower and talked myself into just doing it. It wasn’t that bad (ladies, it’s kinda like pulling out a long tampon – just a different hole). However immediately afterwards I was expecting some form of relief. WRONG. I was in just as much if not more pain. My kidney and bladder were spasming so much for about an hour, and I had already taken all my pain medications. It’s finally starting to calm down now but wow, this day procedure was a doozy!

    Good luck everyone!

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