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 and La Canada, CA. He is the founder of the www.KidneyStoners.org website.

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John

I am a 70 year old male, I had lithotripsy done to me twice in the past month due to three large stones plus having BPH, very large prostate. I had a stent left in me both times. I felt discomfort in my left kidney due to the stent being left in there. The first stent was left in there 24 days due to surgery scheduling. I was give two mild pain killers which I only used for three days, I had a lot of spasms but fought through them, it did not stop me from any normal activities. I still mowed 3 1/2 ares on a zero turn mower once a week, I umpired behind the plate at our local Little League baseball games, I kept busy helping a friends auction house every Friday. I am a 70 year old man, so I could not climb trees or wrestle around, but I had very few limitations. I just had the second lithotripsy yesterday and a new stent put in place. Today I walked a mile, mowed my 3 1/2 acres and will be umpiring behind the plate tonight. My only issue is having to pee 40 times a day so will play that by ear tonight at the game. I get this stent removed in 12 more days. But my stones are gone.

Laura Grammer

I had lithotripsy 8 days ago, was in agonizing pain the next 2 days and still can’t do anything except try to sit comfortably, walking isn’t an option, I go to the bathroom at least 40 times a day.. No one explained what I was having done to me, I still haven’t met the Dr that did this to me!! She made a brief appearance after the procedure to my brother, still no explanation as to what to expect! I coughed really hard the 2nd night and felt the stent shift, I called the office and was told not to worry? I bled for several days, thankfully that has stopped.. I have no idea what is going on? The stone was lodged in my right kidney but now I have sharp pains in my left kidney! Can someone please help me? Is this normal? Between the pain from the stent and now left kidney pain I’m completely befuddled and no one at the Drs office will tell me anything! The surgeon I did see and the one that did this both said since my stone was lodged in my kidney and it couldn’t be the cause of my pain, my primary care Dr disagreed with them so I had this so called procedure done, I’m mad at him too! I will get the stent removed next week in the Drs office, I have searched high and low and cannot find a string so I’m not sure what to expect? I really don’t care if the removal hurts, I want this nightmare to be over with!! Should I expect my left kidney to continue to hurt? Is any of this normal? Of all the times I’ve had surgery I always met my Dr, discussed what was going to take place and knew what to expect when I returned home. This was definitely not the case, I’m mad, frustrated and in severe pain, my life has come to a complete stand still, I can’t eat, I don’t sleep and I’m starting to get depressed, actually I’m already there…. I welcome any advice!

Bab

I had my third procedure done 9 days ago. I had 2 large stones in my left kidney. One in the top lobe that the doctors knew about and one in the lower lobe. They used laser on surgery #1 and supposedly burned the laser gun out after finding a 15 cm or 3/4 inch stone in the lower lobe. Anyway, I had an internal stent from procedure/surgery #1. About 3 weeks later they tried lithotripsy on the stone in the lower lobe and inserted a removable stent with a string taped to my opposite inner thigh. They took that out in 5 days which was too soon because stone chunks were still falling out that morning and I told them so. After a couple more months I had a sonogram and the a CT scan an whops, still chunks in left lower lobe. 9 days ago I had yet another laser procedure on the left overs of the stone. I now have an internal stent that he wants to leave in for 6 weeks which is the limit. I hate it! But the pain of the passing pieces of stone would be worse. All I have taken is 2 or 3 Ibuprophen every 6 hours. Dr. gave me prescription meds which I took the first day and the second but this has worked fine with some pain. I agree that there is a terrible communication problem with this particular specialty. I literally called every day during the last week trying to find out what was done. He did not bother to meet with my companion after surgery to tell him as he had done the first time. I am waiting to see if they are going to put me out for the 4th time or try to remove this in his office but so far have no surgery date. Sorry you are going through all this and I hope someday this is over with. Hang in there. At least we are gaining on it!

Had laser lithotripsy and stent was put in 4 days ago and I now have uncontrollable urination. What is causing the uncontrollable urination?

Bab

I think it’s the stent. I imagine you have one. Kind of works like a gutter spout. I can finally go to the grocery this next week I hope without wetting my pants I hope. The first week I have to stay mostly at home. Gradually gets easier to control w/pad. BTW, this is the 3rd stent I have had in the last 4 months. This one was 9 days ago. Description in above response. Oh, and I am supposed to be drinking 92 oz. of liquid a day which doesn’t help. I can’t drink quite that much but all the liquid is also not helping.

Scott

To everyone that left comments here – THANK YOU for giving me the courage to pull out my stent. We’re experiencing another ice storm in Texas and my doctor office has been closed for a few days now, of course when I was scheduled to have my stent removed (with string). I am a repeat offender over 20 years, having had 5x cysto lithotripsies with multiple stents, but always to this point without string. The last removal was with rigid cysto after 2 weeks, and the removal felt like I was having my soul pulled out, extreme pain followed by about 30m of numbness. I encrustinate quickly and was terrified of leaving the stent in any longer than absolutely required, and pushing 3 weeks post laser for 5x stones > 1cm, so I took a few pain pills, drank as much water as possible, took a steaming hot shower, and very gently started pulling. After a few seconds I felt the familiar pressure but NO pain – just discomfort. I had to stop just when I thought the stent was ready to make an appearance and adjust my grip on the string as I was running out of room to pull with confidence. Another gentle pull, lots of pressure and out popped the entire stent. 20m later I have some mild stinging on exterior but no flank pain, no trouble urinating, I am amazed at how much easier the strong method was vs cysto retrieval. The only thing I would advise considering if you have an option of choosing the string is it’s very, very obtrusive compared to no string, it’s been 3 weeks of hell trying to sit, sleep or walk as the string catches on underwear and irritates the urethra, making every sit-down an unplanned prostate exam feeling. Long story short, you can do this!

Female 56 I had a stent put in today but I think maybe it got caught on my underwear and help pull some of it out as the string is about 10~12 inches hanging do u think it’s just a really long string?

Scott

Mine was shockingly at least that long, same length as the stent. Just keep pulling!

BowDowntoZod

Having had a stent recently, for the first (and, hopefully *ONLY*) time, I have to say that the removal of the stent almost caused me to pass out. Not just the removal, but the insertion of the tool used to grab the stent. That pain did cause me to clench and no amount of them telling me to “relax” helped! They missed the stent on the first attempt, and the doctor had to “reposition” the stent…more pain and discomfort, more clenching. When he finally snagged it and pulled it out, it felt like I had been smacked on the back of my head and I saw stars and left finger imprints in the arm rests of the patient chair I was reclined in. I would not qualify this as “discomfort” but full on sudden pain. I don’t want to do this again…

J Rickards

I had lithotripsy 2 weeks ago for stones that were 10, 14 and 16 mm in size. Stent was placed and was very “noticeable” to me for the entire two weeks. Chronic urge to have to urinate and felt like a bad UTI. Stent removed in doctors procedure room, took about 3 min and was uncomfortable but not awful. Bleeding and discomfort for several hours after but feel much better today!

Daniel

I’m a 63 year old male and after having a 7mm stone in place for over a month, the doctor at the hospital ER said it was time to have it removed. Had the stone removal procedure while still at the hospital which was pretty convenient. The doctor placed a ureter stent with the attached string and said I could remove it on my own two days later. Of course I was apprehensive and debated about doing it on my own. Eventually I decided to man up and do the removal on my own. It’s recommended to take a pain med before the removal. I really thing this is more for calming your nerves because removing the stent was not painful at all. I stood in the shower, and just started a slow and steady pull on the string. Understand that the string is about 10-12 inches long and the actual stent is about 12 inches long so that’s about two feet of pulling. Just keep pulling with a steady motion and then in about 5 seconds you will notice the stent. Just keep going and in a few more seconds the entire thing will be removed. No pain at all, it was just more apprehension about removing it myself. That can be overcome. I glad I did it myself because I was more worried taking the 1/2 hour drive to the doctor and having to urinate before I got there because with a stent in, as you know, once you feel like to have to urinate, you only have about 6-7 seconds.

Stent was annoying for two days then I did an at home removal. Removal went very smoothly and I was blessed to have no kidney pain/spasms as some have described. Here are the most helpful hints I gleaned from this site:
0. Expect the best. Stressing about it only makes it worse.
1. Take pain meds 1 hour prior to removal.
2. Get your bladder full.
3. Stand in the shower.
4. Start the flow of urine to open the pathway.
5. Slowly but firmly pull and keep pulling till it’s out.
6. The knowledge that the string is longer than you might expect and the stent is 10-12” long is also helpful.
Also, I caught more grit in the funnel in 2 hours after removal than I did in the two days from the procedure to removal.
Here’s wishing your experience is as good as mine was.

Scott

thanking mine iut here in 15 minutes

Hanna

Thank you! This was the info I was desperately seeking!

Donna Gippert

Thank you. I had a 17 mm stone removed and the stent comes out on Saturday. Thank you for posting these tips! I will definitely follow them!

Juls

I had the surgery Friday with a stint placed, which is giving me more pain then the stones!! The stint is suppose to stay 8days but this morning I see the string is 4” hanging out! I feel like my body is ridding it for a reason. Any body else have one start slipping out?

Michele

Having the same experience.. supposed to leave stent until Monday but I accidentally snagged the string and tugged on it. It’s been very painful since. How did your removal go?

thomas kimble

Had a stent in place for 60 plus days after small stone clusters and occluded ureter, had the small surgery removing that stent and a second stent placed with a string (suture string) to be removed 4 days later. I removed the stent on my own, ran a warm shower on advice from the nurse, I made a steady pull and almost two feet of string hanging out with no stent in site, I continued to pull and there was that huge white stent, curled on both sides. What a relief. I’m sitting here writing this 10 minutes after pulling it. Good luck

James

Male 60. Had my stent removed after 18 days post op via scope. Very strange sensation, not painful just a.tad uncomfortable. From.start to finish it was 3 minutes. The WORST part for me was my Doc’s nurse handling my penis for 3 mins while he did the removal, Check your dignity at the door. lol.

My Uro doesn’t use the string stent anymore. He told me he’s had too many issues with low patient compliance with too many of them taking them out too soon, too late, or stopping halfway with numerous readmissions to the ER. Now he has 100% compliance 🙂

Melissa

I had a utereroscopy litheoscopy done yesterday to remove a 1cm stone. My doctor placed a stent with a string that I can remove myself in 4 days. Any tips for removing it yourself? He said it should be no problem, but I’m a bit nervous! So much pain and discomfort with the stent- I’m looking forward for this to be over with.

Lane Crawford Christian

Hi Melissa, kidney stones are not fun. I had a stone (5.5 cm) zapped by going into the bladder, up the ureter and into the kidney. I had this done May30th. I just looked in there because I can remove the stint in the morning. No string. OH NO, lWHAT NOW??

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