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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263 Responses to How is a ureteral stent removed?

  1. kelly says:

    Hello had surgery to have 8 mm stone out. Had stent in no fun for 1 st day I felt like peering myself. Went in had stent out in office no problems. About 2 hours later sharp pain in Kindey for a while..

  2. Mary VT says:

    I have had 7 ureter stents in for the last 21 months. It gets replaced every 90 days. I have ovarian cancer and the largest tumor has been pressing on the ureter not allowing for proper urination. My cancer is inoperable so chemotherapy has been shrinking the tumor. Both my urologist and my oncologist feel we can try to remove the stent to see how I do. The removal will be next Wed….I am soooooo excited to think of finally being able to live without this thing. Only 2 out of the 7 stents have been pain free. 5 of them have caused me pain every day. You do get used to it but it is tiring. I will let you know on this board how the removal goes! YEAH!

  3. David says:

    I just had my stent put in today, doc was able to remove the 8ml stone while inserting the stent so atleast thats out of the way, except I have to say I have never felt sooooooo mcuh pain while urinating, I fell like Im peeing razer blades. Im afaid to drink water because I dont want to urinate :-( I soo hope that in 3 days when I remove the stent it wont hurt as bad as I’m feeling when urinating. Doc said I will prob have some pain meds before they pull it out to lessen the uncomfortable feeling. I so wish they could put me to sleep as I believe it will not be just a weird feeling being that I will have it removed so soon. Anyways thanks all for the post’s as I did see some of you had an ok experience with the removal process. Wish me Luck :=)

  4. Joel says:

    The string had gone back up just inside “the tip” as the Dr called it. Still had to have the lube squirted in and had to use the scope but not very far in. The thing felt like a dock rope being pulled out for just about two or three seconds but that was it. I kept it to remind me of what happens when I don’t drink enough water. I have bottled water sitting in every room and every vehicle except the Harley now.

  5. joann bannister says:

    do you always have to have a kidney stent removed

  6. thomas weatherly says:

    Yeah just removed my stents myself, no problems, a little uncomfortable but no pain. Thank God no way as bd as it sounds.

  7. Maria says:

    I just had my stent removed n I feel do much pain is there anything that I can do to stop the pain?

  8. Kevin says:

    I took Prednisone & Nifedipine when trying to pass the kidney stone. Theoretically, I took these to make the stone’s passage through the ureter & urethra easier. I also had a stent inserted.
    So my question is: Is it possible that taking one tablet of each of these sometime before I remove my stent make the removal process a little easier?

    I’ve gotta admit, I’m not looking forward to removing that thing, even though everyone says it’s uncomfortable but not painful. I’m sure it’s mainly just a mindset thing, but when I have to do it in seven days, I will not be a happy camper.

  9. PE Straley says:

    I just pulled my stent out (5 days after stone removed). They had the one with the string so I could take it out myself. I took a muscle relaxer & Aleve one hour before I took it out. I peed, put a towel on my bed, laid down & slowly removed it. It was about 12″ long. The entire time I was pulling it out, urine was coming with it. I couldn’t stop during the procedure, I wanted it out, now! So I soaked my bed beneath the towel. I recommend you put plastic wrap, or a bag underneath if you are doing this procedure at home. It was not painful. It was uncomfortable. I had to remind myself the entire 1-2 minutes I was pulling, to relax. It was not a terrible thing. Hopefully the bloody urine will now stop.
    Hope this helps someone. Wish I’d read this before I did it. No one said anything about urine leaking out during the entire removal.

    • T Seeds says:

      Thank you so much PE…I have to remove my stent tomorrow morning…the hospital pretty much just told me to “pull it out”……no other instructions! Thanks again!!

  10. carol clunan says:

    Had kidney stone blockage and had to go for surgery. Stone was 7 plus mm . It all depends on the doctor. Mine with blasted July 10th and I went to office where he removed the stent on the 17th. Never took pain meds. No problem whatsoever and no pain when he removed it, A tiny uncomfortable was all. No problem with stent either.Hope all of you don’ t panic about stent removal.

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