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?
- The stent can be removed without performing cystoscopy.
- Patients can remove their own stent without waiting for an appointment or having to come to the office.
- 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?
- 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.
- The string can be a minor annoyance.
- 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
- Use a cystoscope to enter the bladder. (A cystoscope is a camera that can be placed into the bladder).
- Identify the stent.
- Use a grasper to securely grab the stent.
- 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.
Its not as bad people make it to be, mine took ten seconds and came out fine… It’s just a weird feeling that is it… But yes, I did work myself up for nothing… It’s just a pain in the butt having a string hang out, you can’t sleep right, sit right, but other then that, it’s easy to remove…
when pulling on the string were you standing or lying down
I have a stent in me. I get it removed Tuesday. I’ve been in the worst pain. They said it was a trade over if they wouldn’t have put I wouldn’t be able to even pee because I’m so swollen. My medicine has not helped me one bit. My doctor told me I’d have to deal with it. I’m not trying to scare anyone everyone’s body works different. I also stopped taking my medicine because I would get really constipated today I finally had bowel movement on my own. But I’m concerned are you supposed to hurt when you pee? Also I pee out a lot of blood? I’m so tired of being in pain and my doctor not helping me and so is my family. If anyone can give me more information please do. I’m only 18 and this is the first health issue I’ve had for years and I’m just really scared and tired.
Hey Ashley! Hope everything went ok with the stent removal. I’m getting mine out today. Can’t wait… Are you feeling better? I know those pain pills are of little help to me also. They just make me tired and unmotivated. When I was taking Vicodin I also got really constipated. I had to start taking laxatives. Now I’m on Percocet. Helps a little more than the Vicodin but still have pain. I’ve found that people are unsympathetic when it comes to kidney stone issues. They assume that I’m in pain for a day or so, the stone passes, and I’m ok. Wish it was that easy. I am a frequent flyer at my local ER. They see me and they get the syringe, fill it up with pain meds and I lay there for 4 hours, eventually feel better, go home, within a few hours the intense pain is back. This whole thing just really sucks! Gotta have faith I guess. Hopefully it will all be over with soon and I can get my life back. Hope you can too, Aslhey. Have a good one!
I just pulled out my stent about 30 minutes ago after being in for four days. The anxiety leading up to the removal was crazy. I was expecting lots of pain at the area where the stent was exiting. Honestly just uncomfortable in that department. The pain that I’m having on the left side of my back is indescribable. It feels like a kidney stone all over. I hope this subsides soon. Pain killers aren’t touching it.
I am a patient with a very low pain tolerance. How much pain will I feel? The stent has been in for 4-5 months. I don’t know if it will be the scope or string.
So glad I found this board after 2 months of having this damn thing inside me! I got the call Mon AM and he agreed to do it in the office this past Wed.!! So much time saved from having to go for pre-op testing, OR, recovery, etc. I was definitely nervous but so looking forward to it! Got there, the assistant put a q-tip with numbing gel (novacaine) INTO my urethra..omg, it was hot feeling…then she left the room and I started having my stupid panic attack even though I had taken a whole percoset at 8:55 am! The doc finally comes back in and gets it started, I was a little nervous, it felt just weird!! He kept having trouble with the grasper keeping ahold of the stent and every time it slipped, I felt it banging against the back of my bladder..That went on about 2-3 minutes and then finally, here it comes! I told him I think Im giving birth LOL..he held it up and said..Its a boy! Whew, finally! He helped me sit up on the table and his assistant asked if I would like a coke..yes please!! So she brought me in the coke to drink and left me there all alone with all these crazy looking instruments AND the stent! Well, call me crazy but I wanted that damn thing so I got up, wrapped it up in 6 paper towels, got my pants on and walked out of the room and for the first time in 2 months, could walk normally instead of hunched over and walking ever so gingerly..it was great!! I had some cramping a little that night and into the next morning and now I am back to normal, whatever that was LOL! Good luck to everyone with these damn stents! Its amazing that they feel like coat hangers and you piss razor blades but its made of soft plastic! WTH?
LOL!! Oh my gosh!! They gave you a coke?? That’s great! Somehow I doubt my Dr is gonna offer me anything to drink. I just don’t see it.
I can’t imagine having this stent in for 2 months!! I feel like I have to urgently get to a toilet and nothing much happens but what does manage to dribble out of me burns like crazy and it just never goes away cuz I’m doing this ALL. DAY. LONG. 24/7. But I’ve only had a stent for 2 weeks and it’s coming out today and I just know it is going to hurt cuz it just burns like hell!
I’m hoping this experience is going to end after this is removed. I’ve had enough. Good day.
I have had a stent in for almost 8 weeks now due to a strictured ureter from my partial nephrectomy I had done for renal cell carcinoma. I have hated life with this stent in! Can’t go far from home or have a long grocery shopping trip without having to go pee 3x! So Monday, I see my urologic surgeon who put the stent inside in a hospital setting, general anesthesia, the works. He said he would take it out next week…Im thinking YAY! Well the office called to schedule this morning, it is such a hassle getting everything correlated and then she came up with this…MAYBE he will take it out here in the office, that way I won’t have to miss work next week to go for pre-admission testing, a 48 hour urine culture…well that sounds much easier to me but reading these posts, whew! Should I have it done in the office and go through hell for 5 minutes or have it removed in the hospital where it will be hours?! Im scared, nervous and confused but so glad this coat hanger is getting taken out!
I have had kidney stones before actually three times two times on my right kidney and now two times on my left kidney. Now this last time (4th time), the pain was tremendous, just off the scales..PAIN. I went to the ER and after eight hours, the doctor tried to break the 9mm stone by lazer but the stone just went back up into the left kidney, he placed the 12 inch urinary stent. A week later, I was back in the hospital to have the soundwave lithotripsy procedure done. I still have lots of pain when I had to urinate, two weeks went by and I was able to produce some small stones for analysis. Well taking out the stent was an ordeal itself, having that numbing gel inserted was not comfortable at all. It took the doctor less than a minute to take out the stent but going in, that did hurt I could feel that scope being inserted and the wire passing by the prostrate and pulling the stent out felt like having a rope burn going passed your prostate and bladder then out. I saw there was water on the floor, I had to go to the bathroom right away when the doctor was done. I felt like I needed a diaper because the area was numb and didn’t know nor could I feel if I was urinating on myself. The whole experience was very uncomfortable and a quite painful. Now I have to see the doctor in a couple of weeks to find out more about my stones. Almost two months of nothing but pain, but now I am just drinking as much water as I can. Take care ya’ll and hopefully we all don’t experience these kidney episodes again.
[…] idea what I was agreeing to. The night before I had to do it, I made the mistake of looking it up online. To say it was gnarly is an understatement. I felt like a clown with a scarf or one of the girls in […]
Removed my own stent this morning. I just grabbed the string and started pulling slowly but firmly. It moved few inches, then I pulled little more and I could feel the stent coming through bladder to urethra. It felt odd, but not painful. The stent is very soft rubber. I then just pulled the rest out and all was fine. Next urination had couple small blood clots, I had touch of discomfort in urethra, left testicle and kidney. But…..it is not painful to remove. Before I removed stent I read many saying it was worst pain ever. Don’t work yourself up about the removal of a stent, it was easy.
just had my stent removed and man it is so painful. can hardly sleep. Please help the pain is too much!
Just had my stent removed a couple of hours ago, hot bath, heating pad, lots of pain meds. Its a little better at the moment. Thought I would feel so much better after. I wonder what causes all the pain after. My nurse said she.s never seen this before. Surely im not the only one.
My husband had kidney stone surgery yesterday afternoon he also had a stent put in and has to followup in a week to have the stent with string attached to it removed he is now concerned because after leaving the hospital last nite around 8pm the string was not far out and today the string is hanging out more than it was after the surgery is this normal he is worried that the stent is going to come out on its own or the string is gonna come off the stent. I don’t know what to tell him to ease his anxiety please help any advice would be much appreciated and another question when having the stent taken out will they give you any medication so it won’t be so painful again thank you
Occasionally, stents with strings attached can be accidentally pulled out either entirely or partially. If a stent is partially pulled out, a patient will usually experience or see:
1) Steady urine leakage from the urethra because the stent has been pulled down past the urinary sphincter which controls urine flow out of the bladder
2) Visually see the plastic stent if it has been pulled out far enough
If neither of the above is true, the stent is probably still in place. Also, it is very unlikely for the string to become detached. If this were to happen however, your urologist can still remove the stent by performing cystoscopy. As always, if you have concerns that your stent has come out before planned, talk to your treating urologist for guidance.
Had 9 shots of whiskey before I pulled mine out today Barely remember doing it
finally pain free
I am having lots of discomfort while having this stent in, I still have a week left until removal but thinking of removing it myself…..
I found the stent entirely uncomfortable, the removal was incredibly painful, but once out, I was fine. No spasms, no pain – just finally felt normal.
I had ureterscopy and lithotripsy under general anesthesia to remove stone which would not pass. Had stent left in place for one week. I was really dreading removal when the doctor offered nothing but numbing gel in my urethera, but have to say it wasn’t bad at all (and over in under 2 min). What was awful was the renal colic that set in about 30 min later. Of the whole procedure the pain after stent removal was the worst. Fortunately, it subsided after an hour or so, though I had some discomfort urinating for a few days.
stent removal was the single most painful event in my life. Felt like I was being sliced open with a serrated knife. I screamed so loud that it frightened the nurses in other parts of the office. Not using general anesthesia when removing these stents, imo, is cruel.
I have never heard of removal being this painful. I think the procedure, like all other medical procedures, is dependent to some degree on the skill of the practicioner. If this were me, I would be finding a different urologist for any future issues.
My experience was similar to Jim’s.. it was horrific. There was no numbing gel.. they just rammed the cytoscope in and pulled the stent out. i have a good tolerance for pain, but i yelled out when the scope went in, and felt sick and in shock after it was done.
There has got to be a better way, and I’m sure it’s all about minimising costs to the Health insurer rather than care for the patient.
My Husband had to have an operation to remove a kidney stone and the Dr placed a stent. Now my husband has to have the stent removed. His Dr just seemed to organise for the stent removal to happen in day surgery but I am really not keen on him going under again so quickly, and from what I have read while a little painful the procedure is over quite quickly. What do you recommend?
There are certain situations where it may be preferable to remove a stent in the operating room, such as when there is concern that are still residual stone fragments that still need to be removed. As the circumstances in each patient’s case is unique, you may want to talk to your husband’s doctor to find out the reason why he or she is recommending removal of his stent in day surgery.
After the 14mm kidney stone that was bouncing around in my kidney for 6 months, i’m sure the stent removal will be less painful. The colic was an 11 on a scale of 1-10. My biggest irritation is with the string hanging out. Every time I move, the string slides in or out and rubs making me fell like I have to urinate. If I sit the wrong way it pinches, if i walk the wrong way it stings. If I sneeze I see stars. Pain killers do nothing! I tried over the counter urinary burning relievers, useless. Two more days if I don’t yank it out myself before that, hell if they can’t remove it painlessly I might as well do it myself.
Its out! A day early. Dropped my pants, the PA pulled the string, 5 seconds later it was all over. It was no worse than passing a little stone.
I felt great til about 30 minutes later on the ride home when I got a nasty kidney spasm that lasted about an hour. I’m not looking forward to more of them.
I am feeling the same pain with the string. sleeping is very difficult. if the penis tries to erect, it stings and wakes me up. I also have blood in my urine. my urine is colored red and yellow. it has been 12 hours since my surgery and it is still bloody. have you experienced this as well?
Im going to have my stent removed tomorrow morning. Im a lil nervous n kind of scared. After reading the comments above im not any more relaxed. But i cant wait to have it taken out. I mean it cant be anu worae than having it in. Can it? I mean its like getting kicked in the groin everytime i go urinate. Pray 4 me you all.
Just had it removed. Wow. How horrible. This was one of the worst things that has ever happened. Since they couldnt pull the stents string they had to stick a camera to find it. Damn. What a horrible pain. From the beginning to the very end. I hope i never have to have a stent put in ever again. It sucked for real. And they leave your urethra full of lidocaone gel that feels like that burning feeling you get when you stop peeing have way. But i dont feel anymore pain when i pee though. But again horrible. A 10 on the pain scale.
I just had my stent removed this morning, after having it in Since October. It hurt for a minute or two whilst the doctor was trying to get it out. I clenched my teeth then it was all over.
I am having a little bit of stingy pain when I wee and some blood, but other than that feeling really good and glad to be rid of that pesky stent!
For anyone yet to have theirs removed, having the stent put in, was 100 times worse than having it removed!
Good Luck! 🙂
Last Monday Jan 23, 2012 I had to remove my stent that was put in on Friday! I was very nervous about this all day on Sunday (I was dredding it). One hour before I was thinking I might be ready to pull the string, I took 2 pain pills and then tried to relax on the couch. Once I could tell the pain pills were doing the job I went to the bathroom. I was so built up with angziety, (took me another hour) I took the string and did a couple of small pulls. Then with a firm grip of the string and a steady pulling I began. Now the string is pretty long so don’t panic if you don’t see the stent right away! So when pulling the string out I thought or was ready for pain in the kidney but had none what so ever (surprised me). I just kept pulling string and once you pull the tip of stent out it comes out faster (a relief feeling)! I did have some blood, but not bad. Yes i had some pain, but not as bad as I had made it out to be before hand.
When I have to go threw this again, I will recommend to use the string!
Today my Dr will removed my stent..I’m very nervous about it.My question is should I take my pain pills before the procedure? I don’t want to feel any pain after what I went thru last week.My surgery was Thursday and I still feel discomfort from all the pain and agony at the emergency..
The discomfort associated with stent removal is usually momentary for most patients. Some patients actually have very little discomfort while others do experience some pain. If you are concerned, taking prescribed pain medications as directed by your doctor may lessen the discomfort you experience and help to relieve your anxiety about the upcoming procedure.
My husband and I are considering the ureteroscopic kidney stone removal. We are both very concerned about the stent removal process if the string is not attached, especially after reading some of the above questions. We would appreciate knowing what the possible reasons are for leaving the string attached or not. Thank You!
There are a few reasons why your urologist may decide to leave or not leave a string. These include:
1. The anticipated length of time a stent needs to stay in (when a stent needs to stay in longer for healing purposes, a string is often not used to avoid the stent from being removed early by accident
2. A patient’s comfort level with having a string “dangling” out of them
3. A patient’s comfort level with removing a stent by pulling on the string themselves
4. How difficult it may be for a patient to return to clinic for a cystoscopy to remove a stent without a string (for example if a patient lives far away from the clinic)
5. Your urologist’s professional experience and preference (use of a stent string falls under what we call “surgeon’s preference” and urologists will vary in their opinion about its use).
Ultimately, we recommend that patients have a conversation with their own urologist about whether a stent string should be used in their situation.
I had a stent removed from my left kidney yesterday and now my lower back is aching on the same side. Is this what I should expect for a couple of days?
Yes, it is common for patients to have some residual pain after a stent is removed. This can last for a few days. If the pain persists for longer than that or if it is severe, you should contact your doctor for further advice.
Blessedly, I had my stent removed quickly and with little fanfare. The nurse/technician performing the procedure (“I do all the work… he – the urologist – gets all the money”) was right when he said you will hate my guts for about 2 seconds, then it’ll be over. He counted down from three, said to hold my breath and he pulled in one swift non-jerky motion… The stent came out as it was designed to do. (I did really hate him and everybody else, but only for a few seconds.) After that, I celebrated!
I had a stent removed via cystoscope this afternoon and it was beyond pain – I would have given it a 10 on the 0-10 pain scale. I left the office feeling utterly beaten up.
My husband just had his stent removed. Is it normal for him to continue to have pain in his kidney area for awhile?
It is common for patients to have residual pain after stent removal for a few days to weeks. The pain usually will go away gradually by itself. However, if your husband has severe pain, fevers, nausea/vomiting, or other concerning symptoms, you should contact your urologist for further evaluation.
my 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!!
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.