Ask us: My boyfriend needs to have his stents removed in the operating room

In our “Ask a kidney stone doctor” section, we field questions from stone formers or their family members. See other questions and answers or ask your own question here.

December 16, 2011

Question about removal ureteral stents:

“(M)y boyfriend went to his urologist yesterday to have his stents removed, I am confused because the research that I have done would suggest that since he had strings attached to his stents that it should have been a fairly simple process, however, this is not the case. The urologist did not have strings to pull out the stents? Did the strings coil back into the bladder? He used a scope to go in and he said locate the strings which he could not do? He pulled the scope out had my boyfriend empty his bladder then went back in again VERY PAINFULL!! again said he could not find the strings due to too much blood? Why at this point would he be looking for strings? shouldn’t he be looking in the bladder for the stent itself to pull out? I wish I would have researched this prior to our appt. so that I knew to ask questions, he now has to go back to a hospital OR setting and have to be put under to have the stents removed, it this a common occurance or should we be concerned? HELP!!”

Answer:

Most ureteral stents come from the manufacturer with long strings attached. These strings can be left intact, shortened, or removed entirely.  If the string is left intact, they will usually extend all the way out of the urethra, where they are visible. For various reasons, urologists often instead either shorten the string or remove them entirely. When this is done, because the string is not visible outside the urethra, a cystoscope will need to be advanced into the bladder where the string or stent is grasped and the stent removed.

While the process of stent removal in the clinic using a cystoscope is often straightforward, it can be made difficult or unsuccessful when there is blood in the bladder or when the stent retracts back into the ureter. In the first instance, blood can make it very difficult to see the stent or string. Because strings in the bladder are longer than the visible portion of the stent itself, a urologist may choose to look for the strings instead of the stent. When this still fails, going to the operating room will allow larger instruments to be used that provide better irrigation/flow to successfully visualize and remove the stent(s). In the second instance, stents can sometimes withdrawal back into the ureter after they are placed. This means no stent is visible in the bladder. Removal of these stents also usually requires going back to the operating room where a ureteroscope can be used to go up the ureter and grasp the stent.  Both these situations unfortunately can occur commonly. The good news is that removal of the stent(s) in the operating room is usually straightforward.

Please note that this information is not intended to represent medical advice or professional opinion. Our comments are intended as general information, and are not specific to your boyfriend’s case. Each patient’s case is unique and we recommend that all patients seek care with their local medical professional.