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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335 Responses to How is a ureteral stent removed?

  1. Ashtyn says:

    I had PUJ obstruction on my left kidney. I had day surgery in March 2015 where the urologist put a stent in the kidney. When I woke in the recovery room I felt extreme pain and the doctors said I just have discomfort from the stent. The pain team and my nurse who where phenomenal sat by my bed and tried to control my pain. I am only 16 yrs old (15 at the time of surgery) and everyone told my mother that I was fine (she obviously was not aloud in recovery). The truth is that I was on 3 times the amount of adult pain killers and the pain was still horrible. I remember thinking that I was going to die. I went through this pain for 4 hours until they removed the stent. After surgery the nurse told me that they were lucky they removed it “immediately” because I was under so much pain and my body started shutting down they thought I would die.

    Then in on July 16th 2015, I went to Brisbane to have a laparoscopic pyeoplasty. This surgery went great and now my kidney is functioning as it should. One thing that frustrated me most about my condition is that I went to the emergency room several times and every single doctor said that they don’t know what to do.

    The chief doctor or whatever told me that I was just being a sook and probably depressed and that’s why I have the pain. He came into the room and told me that I was just missing my boyfriend. So I told him that I don’t need men to fill my life. I am extremely angry that he treated me this way and dismissed my case telling me nothing was wrong. Idiotic doctors should get away with this kind of stuff and know that you can report them. The process is long but I am in the middle of it now.

    Moral of the story: Don’t trust one doctors opinion because you could have a serious medical problem.

  2. lisahollis says:

    How long should a steint be in ,and if bleeding occors,while steint is in what do u do .thank u this has been very interresting,andenjoyed the viedos and understand the process of putting one in and taking one out alot better my son is going thur this removeal process today.sinserlly,yours,lisahollis

  3. Max Lecaros says:

    A urologist lied to my mother and stated she was dying. He also lied and said her white blood cells where high which they were not. My mom had a very strong pain in her back and stomach area and I’m sure she could of been cured with medication and rest. She had a 5mm kidney stone showing in the cat scan from the emergency room when she called 911 because of her pain. We went to go see a urologist 2 days later and the urologist rushed her back to the emergency room to set her up for surgery the same day he saw her. This doctor almost killed my mother. When mom was seen first in the emergency room when she called 911 they did blood work and her platelet levels were normal. 250,000. her white blood cells were perfect. When we went to go see the urologist 2 days later he lied and said her white blood cells were high and that she is dying after seeing her for one minute. Please help us he almost killed my mother. Her platelets dropped to 14000 and white blood cells rose to 18,000. He butchered my mother inside infecting her blood and almost killing her. Urologist’s like him should loose their license so they stop hurting and harming people. Urologists should take the time to do the best for the patient and destroying a person’s inside for no reason should be punished by law. Please help us. My mother still has the stent inside her kidney and I don’t want my mother dead because of a ruthless urologist who should be in jail. If feasible please contact me at my email so we are not lied again and we do what is best for my mother’s health. The day of surgery mom was sent to icu for 3 days and than 3 more days at the clinic. The urologist stopped by the last day and suggested my mother stay their as she slowly got worse. We went home day five after good doctor from the hospital in Florida(blood doctor) said mom could go home. I’m taking good care of her now and she is recovering slowly but surely with the healthy foods she always enjoys to eat. Unfortunately, she still has the stint inside of her and we don’t know what to do. We surely don’t want to give this ruthless urologist another chance to kill her. Please help. There are criminal doctors out there and they should be put away before it is to late.

  4. Elizabeth says:

    I recently had biopsies of bladder & stints put in. I was really looking forward to my urologist removing the stints after 3 days of horrible pain which wasn’t being controlled with Toradal. The stints were removed in his office, I had no pain, but about 5 mins later enroute home in our vehicle, the pain started & soon after, the vomiting, took a rectal gravol so I could hold down the painpills, I took 2 ESTylenol as well, phoned urologist, left messages to mo avail, until next am from his secretary, who said ‘I’ll take note”. Long story short, pain was controlled for 6 hrs, then 2 hrs of HORRIBLE pain, 12/10 until following early am, pain was just getting controlled, I suffered an M I bcs my BP was so high from the stress “coronary spasm”, spent the next week in ICU, still recovering, lucky my heart has no damage. My kidneys bled+++, creatine levels rose bcs. Of beng put on blood thinners for MI.
    Grateful to be alive, trying to cope with my anxiety from this extremely traumatic experimce.
    Get drugs that control your pain BEFORE you even have the surgery, get a urologist that is available.
    Would I do this again? NEVER

  5. Elizabeth says:

    I recently had biopsies of bladder & stints put in. I was really looking forward to my urologist removing the stints after 3 days of horrible pain which wasn’t being controlled with Toradal. The stints were removed in his office, I had no pain, but about 5 mins later enroute home in our vehicle, the pain started & soon after, the vomiting, took a rectal gravol so I could hold down the painpills, I took 2 ESTylenol as well, phoned urologist, left messages to mo avail, until next am from his secretary, who said ‘I’ll take note”. Long story short, pain was controlled for 6 hrs, then 2 hrs of HORRIBLE pain, 12/10 until following early am, pain was just getting controlled, I suffered an M I bcs my BP was so high from the stress “coronary spasm”, spent the next week in ICU, still recovering, lucky my heart has no damage. My kidneys bled+++, creatine levels rose bcs. Of beng put on blood thinners for MI.
    Grateful to be alive, trying to cope with my anxiety from this extremely traumatic experimce.
    Get drugs that control your pain BEFORE you even have the surgery, get a urologist that is available.
    Would I do this again? NEVER

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