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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638 Responses to How is a ureteral stent removed?

  1. Margaret Parham says:

    I just had two stones removed on 12/8…had one two years ago that resulted in 2 surgeries for one stone and a week I hospital due to infection from the stent….I changed drs due to this I especially incompetence…this time it was due to blockage and my new dr.was able to get the 2nd out as well…my experience with a stent this time was like night and day…yes it was uncomfortable but on a pain scale, 3/10…today is the 14th and am on my way to have the stent removed…this urologist will be by Dr. For good….and I will say….I’ve dealt with 2 to 3 stones a month for the past 3 years…diagnosis…over active parathyroid…once we get this taken care if….no more stones…yeah me…

  2. Bonnie says:

    Omg I just had one removed and let me tell you it was 10x more painful than the kidney stone in my kidney.Pain was there about two hour .Very painful

    • Frankie Nealey says:

      I just had stents removed from both kidneys this morning and yes it was very painful. I had stones removed from both kidneys 12/07 and felt like I was in labor for the past almost week. Thursday through Sunday could not do anything but m through Sunday could not do anything but vomit and take pain med. this was my fifth I think time for Lithotripsy and by far the worst one. I feel that it was so rough because of the stents being put in. So now I’m wondering why were they put in this time and never on the previous surgeries Yes this time was a different doctor from the previous. My previous doctor would not even do both kidneys at the same time. Thank god I wasn’t hurting as bad this morning I actually felt pretty good until having the stents removed and then like from what I’m reading for a few hours I was in pretty good pain again.

  3. Henry Brady says:

    Hi I had two stones removed a7mm on my left side and a 5mm on my right side then I had two stents inserted ,I got out of hospital on 12 Oct. and on stand by to have my stents removed on 14 Dec. the pain in my stomach was so bad that my doctor put me on tramadol and an antibiotic but I got thrush the pain was unbearable and still is the pains in my stomach caused me to throw up 5 times today I stopped taking the tramadol last Thursday I was on 300mm for 7 days but I’m dying here with pain apart from my stomach it feels terrible trying to pee the pain of forcing and the blood I hate going for a pee it hurts feels like trapped urine in end of my penis nothing for it try the hospital again tomorrow

  4. Michael says:

    I must have a stent placed on Monday. I will be under general anesthesia, the stent is to bypass a stone in my right ureter. Unfortunately, the CT scan done at the beginning of the week showed a mass in my bladder. At this point we know nothing more, so this is adding fuel to my anxiety level, and a biopsy will be done in conjunction with the stent placement.

    I do not trust the doctor who is performing this procedure. I did not choose him, and there is no information about him on website, such as medical education, experience and, mostly, patient reviews. Negative patient reviews I take with a grain of salt, as people do tend to complain, but when a doctor receives good reviews, I feel that in all likelihood they are deserved.

    But, the physician is totally opposed to any input from me. I have had stents in the past, with strings, and removal was not a problem. I asked if I could have the same for this procedure, and received a curt, “We don’t do that here.” So, that means removal via cystoscope, which terrifies me. I asked the doctor if I could have some valium when the time comes for cystoscopic removal and received the same “We don’t do that here.” response.

    My anxiety is about the possibility of the bad diagnosis, but at this point it is just as much about being in the hands of a physician who seems to have to empathy at all.

    Doctors seem to forget that when they say “We,” the collective pronoun should include the patient.

    Afraid and nervous.

  5. Melissa R says:

    I had 2 kidney stones. One was 7mm and the other one was 11mm. I went in for surgery on 11/14/17 to have them removed. My urologist was on vacation so I had a fill in. The surgeon could only get the smaller one states he could not reach t he larger one. He placed a stent and let’s just say that the stent pain was worse than the kidney stone. Pain meds Don t work. After 2 weeks of calling my surgeon begging to be seen he finally squeezed me in. The pain by this time was so bad that I cancelled Thanksgiving with my family and stayed in bed. The pain radiated on my side into my groin. I felt like I was in labor with a urinary track infection, oh and delivering 10 children! The blood never went away and by the time I got in to see my urologist I couldn’t function. I was wearing depends, crying everyday and could barely work. My urologist scheduled another surgery which I had this week on Tuesday the 28th. The other stone was removed and the stent was taken out only to be replaced with another. My Dr gave me ditropan for urinary spasms and this medication took all of those bladder spasms away. It was a blessing so ask fo r it!! I have a little back pain now and I feel really bloated. Other than. That i am a lot better. This surgery is awful I’m not going to lie! Your heating pad, ice pack, meds are your best friends. Good luck to all of you and hope you mend soon!

  6. Farooq hussain says:

    I have had my stent removal done on me on 25th Nov, 2017. I felt blade cutting pain for one and half day postpartum and then it disappeared. Today is the fifth day I am feeling good with little sensation in both the ureter though I had the stent in left ureter.

  7. Bill says:

    I had a stent procedure and of course a lot of pain later. Can the removal of the stent of and blasting of the stone by another doctor? The doctor who put the stent does not accept my insurance for the procedure.

    • Jillie says:

      I had a stent placed because of a 1cm stone in my right kidney on Oct. 12th. That I had done in PA. Because we had plans to leave for FL for the winter, we left home on the 23rd. In FL I made an appointment with a urologist who did the lithotripsy on Nov. 17th. Everything was fine until then. When it came time for stent removal, I would get an infection and they wouldn’t remove it. I’m now on my third antibiotic with an appointment to get stent removed tomorrow, Dec. 18th. No pain so far but the string has caused irritation when I walk. I will be glad to have this over.

  8. Danny says:

    Went for a ureteroscopy and laser lithotripsy yesterday for a 5mm stone in my left ureter. I’m terrified of needles and have a below average pain tolerance. To be honest, the surgery itself wasn’t particularly horrible, thanks to general anesthesia knocking me out.

    Woke up to blood at the tip of my penis (expected), and drank water to help speed up some urine forming (if I couldn’t pee, medical staff said they might have to do a IU catheter to let the urine flow). Nurse told me the first was going to be the most painful, but damn, on a pain of 0-10, I’d have rated it about 7-8! Almost broke into tears from the pain itself, and that was after I prepped myself by taking painkillers (tramadol and paracetemol) about a half hour before! After some time, the subsequent pees got less and less painful (6, to about a 4-5 now at home on the second day), I guess partly due to getting used to it, healing as well as the meds.

    Now, most of the discomfort is coming from my sides when I pee, and it fits with my doc saying that it’s due to the stent. I have to get it removed in about 2 weeks, via cystoscope, and the thought scares me, since they have to insert yet another scope into my urethra to get it out. Should I be worried/expecting my peeing to be as painful as that first time post-surgery?

  9. Tammie says:

    Anybody have to have surgery to get their stent removed? I had lithotripsy on November 3 and went to the office on November 20 to get the stent removed. The doctor said it migrated upward and I will have to have surgery to get it removed under general anesthesia.

  10. Cassandra says:

    Hi Karen! I am suppose to go to the doctor to have my stent removed with the string on Monday. I was just wondering if there is any pain/discomfort with this method? I am a bit nervous.

  11. Lissa Chasteen says:

    I just had a large staghorn 2cm stone removed through a small cut in my back along with 3 other smaller stones. The stent was removed by myself and I felt good, Dr told me to eat a regular diet as soon as I left the hospital. I went through 2 bad cases of something inside me causing me to get backed up and ending up in the er with such abdominal pain I couldn’t deal with, 4 days later I’m on liquid diet trying to fix myself because the drs seem to think I can eat anything. I don’t think it has to do with the stent removal but pray to God noone goes through the pain I’ve been in.

    • Jarrow says:

      Taken any antibiotics? Perhaps you need to reset your digestive tract with some OTC probiotics? I had a similar issue Just 2 weeks prior to your post: 12mm kidney stone blocking left kidney, septicemia, fever, crashed to 65/40 bp, etc. After the half-dozen antibiotics I was pumped with, my body simply couldn’t handle food going through the GI tract. Needed loads of probiotics to re-establish a decent digestive system before C Diff. reared it’s ugly head. Still on them, actually – laser lithotripsy in 14 hours and counting . . . . : |

  12. Jenny says:

    I have to go today to get stent removed, I am terrified 😫😫😫😫

  13. Helio Montero says:

    I went today to remove my stent, pain like everything people said about it’s very
    Painful for my surprice the Dr. send me to have XRay too make sure that everything was ok,wait at the office for long time and I got tired, went back home and recieved a call that a piece of the stent still inside my uretra they want me to go back to the office on monday, everytime I pee feels like razor going troughtout my penis. I am thinking to go back to the ER and see if they be able to pull the last part that broke out.Any suggestion ??because I feel pain went i am laid down or sitting up today is 11/3/2017

  14. Cathy Thrasher says:

    I have a 9mm stone. They put a stent in Monday and I’m about to die. There going to do surgery on Nov 10 to take the stone out

    • Nancy says:

      Mine was done on 3 Nov, by the Tampa VA. Mostly nice group of people. I too had a stent placed and a 42.2 cm stone removed. Yes over an inch long. Urologist showed me what that monster looked like on the ultrasound, he said typically they aren’t that big. Why they let me go with that for five weeks is beyond me. However, for a typical surgery that was to take ninety minutes, a problem occurred, and it took almost five hours. As my sister waited in the waiting room, a nurse came out saying that my heart had stopped but I was fine now. I came out of surgery and into recovery, two others were there also (males). Both had come thru with flying colors. When my sister was able to see me, she informed me of what had happened. Not one surgical staff came to talk to us at all. It was not until 8 pm that they decided I had better stay the night at the hospital. Arrived at 9 a.m. left Saturday 5 p.m., drugged to high heaven. My children never got the call of the situation until daughter #4 called me and my sister told her what happened. She was furious and called the hospital. Of course they lied to her and said everything went as planned. In/out in a matter of an hour. I am home with a stent, still in very much pain, bleeding alot more then if I had my monthly. Chunks of tissue, blood, and urine. The doctor told me to come back in the morning to have the stent removed, (today is Sunday). NO one is open in there until Monday 6 Nov. I asked to see the Urologist, and was told that he was not in the hospital. I still have no idea who she was, nor does my sister. Tomorrow I go in to the office to see the Dr that “supposedly” did the surgery and ask a montage of questions and with no appointment. I am very pissed off. Wish me well, as I pray you have a better time of it then I am. This ‘mother’ is very painful more-so than childbirth which I know a thing or two about as I’ve had five live births.

      • Jarrow says:

        https://www.kennerlyloutey.com/anesthesia-complications-routine-surgery/
        Sounds like you should investigate the malpractice possibilities asap, gather what medial records they’ll let you, and get the timelines of testimony down while it’s still fresh.
        My mother had a sponge left in after her surgery, and passed out due to fluid buildup in the chest (couldn’t breathe) with the associated mental injury that doesn’t show up for ~18 months after the hypoxic episode No clue how long you were without oxygen to the brain, you may want to get a cognitive assessment done asap as well, to give a baseline for any memory problems you may experience as a consequence in a year or two. Good luck.

  15. Bob says:

    I am an overachiever and had stones on both sides at the same time – and the first time I have had stones. They were “blasted” about ten days ago and I had stents on both sides with strings. I went back after 6 days for an x-ray and since it was clear, I had the stents removed at the Doctor’s office by a CNP. Only moderate pain doing the removal – and to my pleasant surprise they were both removed on the same “pull”. My only complication was six hours later when I had such severe pain that I went back to the emergency room. They determined that I was having kidney spasms on the one side. Was given morphine and went home after three hours. That was five days ago and I have been fine since then. I am a 64 year old male.

  16. Debbie says:

    I had my stones removed a week ago and must remove stent on 29 Nov. I am so so scared.

    • Karen Melling says:

      Debbie are you doing the removal yourself ? If so don’t be scared
      I laid on the bed with lots of towels to do mine
      Just gently pulled till it was all out
      Such a blessed relief !!

      • Cassandra says:

        Hi Karen! I am suppose to go to the doctor to have my stent removed with the string on Monday. I was just wondering if there is any pain/discomfort with this method? I am a bit nervous.

  17. Asif Ferdous says:

    I just removed my stent today,.after 1 month from operation. It hurt like hell. getting urine in blood and have pain when urinating. I will keep u updated regarding this.

  18. hinata_bokko says:

    So much of what is out there on the web details how awful stent removal is. I’m happy to say that my story is a bit different: mine was removed in-office by my doc, no anesthesia save for local lidocaine, over and done in about two minutes, and didn’t hurt a bit. (Female here; I know that men don’t have it quite so easy and I’m sorry!)

    For two days afterward I had a bit of pain that was similar to kidney stone attacks but much milder. Today is day 4 post-stent and no pain at all.

    • Sharon says:

      This information is very helpful. Thank you, I’m working on day 3 from my stent removal and just starting to feel better.

  19. Kerrie says:

    I have a stint put in have to go back 3 months have them blasted an i asleep

  20. 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.

  21. 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.

  22. 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.

  23. 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.

  24. mr no penis left says:

    it fucken hurts

  25. 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?

    • Jillie says:

      I was brought back after three weeks for another CAT scan to see if my 1cm stone had been sufficiently broken up. They waited that long to give the smaller stones time to pass so they could see what was left.

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