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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596 Responses to How is a ureteral stent removed?

  1. Jennifer says:

    I had my 11mm long kidney stone removed on the 29th of September. Was not feeling
    Having my stint in was uncomfortable, painful at time and burned especially when peeing. I was super excited to get my stint out today and was a little nervous on how I was gonna feel when it was taken out. It went very well, did not really hurt at all, it was more of a little bit of a tingling burn. Felt so much relief once it was taken out. Just happy to not be in discomfort anymore.

  2. Rebecca says:

    I just had a lithotripsy and stent put in on monday. I ended up in er tuesday morning at 230. Ive cant hardly pee and been nauseated ever since. I had one in 2009 and had it removed 3 days later and felt better. Now the stent removal hurts like he’ll.

  3. Sheldon A. Rinehart says:

    I had a ureter stent installed after lithoscopy (sp) on 9/15/17. Procedure went well. After getting home and all week-end the intense need to urinate was almost unbearable. I was urinating about every 5 to 10 minutes. The feeling was painful and I was taking a drug to help the pain to no avail. I am guessing the the string left in me to later remove the stent was causing havoc with nerves in my urinary tract some way. Upon calling my doctor Monday morning, he said to go ahead and remove it. I won’t go into detail about the removal other than to say it was painful. I experienced immediate relief after pulling the string and stent out of my penis.

    • Rebecca says:

      I just had mine done Oct 2. And I’m actually having trouble urinating. No string on mine or I would be already taken it out. The removal hurts like hell though. I had one in 2009 and I done just like you did and had tremendous relief after removal.

  4. Jackie says:

    To be straight up, I was 18 when I was hospitalized for stones. It took me two weeks to finally decide to go to the hospital and be treated. I had to have two surgeries to remove the stones because my ureters are abnormally narrow. When I had my stents taken out, my god, it was easily the worst pain I have ever gone through. I had extreme nausea after the removal, and it hurt more to pee without the stent than with it in. I don’t mean to scare you, but if I was able to pass a stone without going to the hospital for two weeks and deal with that pain but not even bear to do a stent removal, that should be a big hint on how badly it hurts.

  5. mr no penis left says:

    it fucken hurts

  6. Garry Hands says:

    Had 8mm stone in my right kidney for few years urologist said if wasn’t causing me any issues (which was correct) then leave it be. 7 years went by and every year I had to go for x-ray to access situ size etc still no changes so all okay. urologist then passed away and I was seen on last check up by another, he asked why nothing had been done and told me they would have me in for sound wave treatment to break it up. Had this done no pain or discomfort and thought all went well until month later – I collapsed in excruciating pain and fever and needed help getting to hospital the stone only broke in two 4mm bits these left my kidney and totally blocked my urethra up causing my kidney to stop functioning I’ve had stent in now for 6 weeks waiting clear kidney, very uncomfortable and pain when pee each time with incontinence back in hospital next week to hopefully take it out and laser treat stones to pass out – why they never had me back soon after shock wave to check it had worked I dont know?

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