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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398 Responses to How is a ureteral stent removed?

  1. Christina says:

    Well I have to say it was not pleasant for me having a stent put in. I had a 7mm stone which only was able to be broken down into 2 pieces. I will have to go back to get more laser done to break the rest down. The worse part of having a stent put in was the horrible pain that occurs when you use the restroom. Urine shoots back up the kidneys which causes an unbearable pain. Other than that issue. Bed rest minimizes muscle spams and for the most part there was little to no pain. I recommend having a catheter put in. Which will help the bathroom issue. It made a world of difference.

  2. Ankit says:

    Hi, my dad had an operation on 1994 in which the doctors put a stent for removal of stones from kidney. They had asked him to take it out within 6 months. But he did not take it out till today. I want to know whether it be a critical operation or a normal one. Doctors out here are saying it is critical since the stent might break. Plz help

  3. Efron says:

    Hello, had a 5mm stone lasers one about a week ago and now the stent needs to come out tomorrow. This will be do win the doctors office I am scared and worried any suggestions? Thanks P.S. I didn’t feel the stent the whole time it’s been in and I have pently of Nirco.

  4. Olivia says:

    Hello! I am 19 years old and on the 3rd of December I had my kidney stone removed witch was called a staghorn calculus witch is a pretty big stone, I was in theatre for five and half hours and was in hospital for a week! I have the stent in that you don’t pull and will have to have it taken out by doctors I have had my stent in for 8 weeks now and I am in so much pain but I don’t know if this is from the stent because I am passing little fragments of stones?! My pain in my bladder is horrible I’ve been back and forth at the doctors on antibiotics to treat water infection but it does not go away! I always dread going to toilet because I physically feel like crying! My kidney stone has ruined my life as I had to leave university! I am at the hospital to talk to my urology doctor tomorrow. But can the stent cause agonising pain?!

    • Christine Ward says:

      Hi Olivia,
      I have had four stents fitted and each one has been different. I’ve experienced different levels of bladder pain and horrendous back pain and the need to want to hold onto something every time I go to the loo. None have been pleasant and in my view they have totally wrecked my life. Luckily I am retired so don’t have issues with work but I feel for everyone who has to go through this. My Urologist says that 70% of his patients can’t tolerate stents so you’re not on your own. Good luck. My thoughts are with you.

      • Olivia says:

        Thank you so much! I did speak to my urologist and he said the pain will be from my stent and I am now awaiting to have it removed witch am scared for because of the pain, but the pain I have now is horrific and like you said it’s awful to go to the loo! It’s ruined my life since I am only 19 I had to leave university :(

        Thank you for your help Christine!xx

  5. Christopher says:

    I am having a stent removed on Wed Dr keeps saying it’s no big deal, obviously he’s never had one. Should I take a couple percocet before I go in?

  6. Karen says:

    Igot my kidney stone removed and i was wondering how easy is it to pull

    ll

    out the stent myself

  7. wayne beddoes says:

    Had a stent removed yesterday after 13 weeks of serious uncomfortable pain. Two infections and many underwear and trousers ruined by sapositories I had been more than happy knowing it was coming out, little did I know the extent of the pain and discomfort I was going to be put through. Always played sports, broken nose, cracked eye socket, torn ankle ligaments would of all been welcomed again instead of this. No pain relief prior or after procedure. Specialist and two nurses struggling to get the stent to release was unbearable, eventually pulled it out to me being covered in sweat, being grey in colour and having no legs whatsoever. That’s the 2nd stent in 2 years to be removed. 1st was under General this, well my dad may as well of got the pliers out in the shed. Absolutely horrendous. I would advise against local, even though I actually didn’t have any to begin with. Money saving exercise I think!!!!!

  8. Dawn says:

    I’ve had stents 4 times. I get chronic kidney stones. (Heredity ) I just had a 1.5 cm stone blasted on 12/30 and the Stent was removed yesterday. This was the first time I’ve had a Stent without the string. This was awful. I am female. I felt like my urologist went “digging “. The last time I got sepsis and was hospitalized for 8 days. Stent are horrible, uncomfortable, and bloody painful!

  9. Kris says:

    Kris and all – had the stent removed 7 hours ago. I would rate the pain/discomfort at a 1 out of 10. Peed no problem. Doc gave antibiotics and said to take Motrin for 2 days. Hoping for full recovery. Just groggy now.

  10. Kris says:

    Marc, I had the same problem today. The doctor could not find it the stent when he tried to remove it. He had an xray done and the xray tech said it looks like it is where it should be. Tomorrow they will remove it in the hospital and put me out. Looking forward to it being out.
    For the past 6 weeks I have been uncomfortable with it in. I feel the discomfort under my ribs and running down the left side. Lying down or sitting on a hard chair makes it worse. I feel best standing or reclining. Anyone else feel like that?

  11. William Lang says:

    Had two stents removed by cystoscopy this morning, and watched it all. Mild discomfort only, and no after effects. I was amazed at the size of the stents when shown them after removal. I was on the table about twelve minutes.

  12. Mark says:

    Hi everyone, my stent was supposed to be removed today, but they couldn`t find it in my bladder, probably it has moved further into my uretera somehow???? Feel frustrated, wanted this to be over so bad… They`re going to do general anesthesia in few weeks time now and go look for it! Has it happened to anyone? Feel a bit scared as my stent seems to have its own life there and wanders around with no purpose inside me. Thx!

    • Ron says:

      Just had mine taken out through Kidney end as it got stuck in the kidney and would not come out the other way.It was such a relief to get the stent out,the little bit of pain
      from the kidney site of entry but not bad.

  13. J Rose says:

    I pulled the stent out last night. I’ve been miserable since it was placed after several stones were removed. It felt odd but I took Relefen first. I had no pain, just relief from not having that straw in me! First time in a couple of weeks I don’t feel like I need to pee all the time?

  14. Rick U. says:

    I just had my last stent removed via string on 12/21. It was placed on 12/17 after another stent was removed along with my stone that was stuck and could not pass on its own. I was not looking forward to having the stent pulled out via string in my doctors office. I didn’t know what to expect. IT WAS NO BIG DEAL! It only took a few seconds and I hardly felt anything. The urge to pee caused by the stent also immediately went away like turning off a light switch. It was amazing. I went about the rest of my day and felt amazing for the first time in five weeks; the time my first stent was placed. Do not fear having the stent pull out via string. Look forward to how amazing you will feel once it is out.

    • Rod says:

      Did they numb it before pulling it out? Did they pull it out fast like taking a bandaid a sensitive area or slowly?
      Thanks for your post, I will be out of the country and will need to remove myself. Not sure how much vodka I may need first… Again thank you for your post.

  15. Roggonx says:

    I just had my stent removed earlier today. I was so scared and very uncomfortable. At first i did ask the nurses, and they said a mild pain and a discomfort feeling. Suddenly when the doctor injected the local anesthetic i felt a like an ant biting my penis. When they insert the cystoscope the pain was like unimaginable. I tried my very best to relax, took a deep breath. Then few seconds the pulled out the stent. Once finish about less than 5 minutes i felt horrible pain like an insect biting inside my penis. I can’t even standup straight and walk. I had to be put on a wheelchair..now im beginning to feel sensation to pass my urine but im still in agony!! They gave me two pills of painkiller it helps to subside the pain but at times i still feel burning in my penis. The doctor said it will go away about an hour or two..but now i still feel it.

  16. Michelle Fraser says:

    DO NOT AGREE STENT REMOVAL WITHOUT GENERAL ANAESTHETIC
    by Nomad10 » Wed Dec 16, 2015 1:44 am

    STENT REMOVAL WARNING: DO NOT BELIEVE doctors/nurses who tell you “the procedure is a bit uncomfortable”. It is not uncomfortable – it is AGONY. My husband has just come back after this ‘procedure’. After a supposed anaesthetic injection which did not numb the area (fake/placebo??) a gel was applied seconds before they removed the stent. This also did not work. (There was no attempt made to genuinely stop the pain – this was a cynical, money-saving exercise which they knew would cause unbearable agony.) My husband – who in the past has been stoic and uncomplaining with a tooth root abscess – was shouting in pain, screaming for help. When he came out of the ‘procedure room’ he was ashen white, shaking from head to foot and struggling to stand. He says it was the worst pain he had ever experienced and was close to losing consciousness. The ‘surgical team’ did not even offer pain relief afterwards – until I insisted.

    ADVICE to everyone: DO NOT have the stent removed under local anaesthetic – insist on a general anaesthetic. NB: One thing I don’t understand: dentists inject painkiller into your gum then you sit and wait until it takes effect. They check this before using the drill. So why didn’t the ‘surgeon’ make any effort to numb the area/check this before carrying out an invasive procedure on a highly sensitive area?
    DO NOT ACCEPT MONEY SAVING SHORTCUTS – THIS IS AGONISING – DEMAND A GENERAL ANAESTHETIC

    • Stella Clark says:

      I’ve had a stent placed in my left ureter on three separate occasions. The first two removals were fairly painless, though I knew—and the doctor confirmed—the second one had fallen out of place. Now my third stent was a completely different story. It hurt the entire time it was in, and when it was removed, it was AGONY. (Supposedly the stent was built differently from the first two I had and engineered to stay in place better.) I had a little local anesthetic, and when the doctor attempted to grab the end of the stent, I nearly came off the table. It seemed like an eternity before the stent was finally out. Now I have another doctor who plans to insert another stent next month. When I told him I could not tolerate stent removal while awake, he said ok. However, earlier today I was reading the paperwork on my surgery, and I am going to have to remove my own stent!!! Not happening!

    • Dave says:

      Just had my stent removed on Thursday. They just applied lidocaine gel to urethra opening, waited about 10 minutes, and started. While it wasn’t totally pain-free, the pain was mostly what could be considered “discomfort.” After all, you ARE having an instrument put somewhere not designed for it. After the initial entry, helped by warm water injected through the instrument, the only other discomfort was having it get past my prostate. Once past that, it was all done. I was one of those who were surprised when it was all done. Was living with the stent for a month, and very glad to get that out (and obviously my 21mm stone) after 2 lasers and a lithotrispy.

  17. Samantha says:

    Hi I have just had 3 stones removed one at 8mm and the other two at 3mm I had them removed by laser I have had to have another stent in to stop My kidneys being infected and flaring up I have a price of string hanging on to my stent I would just like some information on the stent coming out in clinic painful of not painful I just can’t wait to be better and free of this stent anybody that has has a stent out with the strIng please write to me and give me your view on it

    • Melanye says:

      Hi Samantha,

      I just had a 12mm kidney stone removed surgically, Wednesday, 16, and now I have this awful, uncomfortable stent in me until next Wednesday. I can’t wait to get it out! Let me know how your removal goes. Good luck to you!!

      • Cheryl says:

        Hi,
        I just had a stent removed in the doctors office. I suffered from 3 kidney stones. I had a stent placed to allow the kidney to drain on December 11th to allow the he stones to pass. They did not pass and on Thursday December 17 I had lithotripsy and another stent. I was in severe pain from the stones and even worse the stents. I was taking percocet around the clock. I was having a panic attack today because the stent was coming out. The procedure was uncomfortable but the pain I had imagined was worse than the procedure. I felt a twinge, spasm and some cramping and it was out in less than 2 minutes. I’m home and have some spasms and the awful stent pain is gone. Good luck and I hope yours goes smoothly.

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