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.
I’ve had a stone stuck in my ureter for at least 3 months. I’ve had 4 different days during those 3 months where there were horrible episodes of the stone moving for hours. One day it was a 10 hour experience, another 4 hours, and the last time it was 18 hours of non-stop stone in motion. Complete agony.
So finally, I had the stone removed 3 days ago via ureteroscopy. The stone was larger than it appeared on the CT scans, so the doctor had to break up the stone with a laser, and then remove the fragments. A stent was put in from my kidney to my bladder, and I opted for the method where the string hangs out, rather than having to go have another scope put in me to remove the stent.
To those about to have this surgery, and having a stent put in: What I experienced was (1) I cannot feel the stent in me most of the time (thankfully!) (2) the first three times I peed after surgery (the first 2 being immediately after waking up, at the surgery center), I peed out blood – not as in blood in the urine, but as in a bunch of blood. (3) for the next 4 days, everytime I’d pee, I’d have pain in the kidney, usually about halfway through urinating. This kidney discomfort/pain was worse the first 2 days, and a little more tolerable on days 3 & 4. (4) The urethral opening (pee-hole) really hurt the rest of the day after the surgery was done; this gradually got better on day 2 and even moreso with days 3 & 4. (5) The strings sometimes drove me crazy, and burned or caused discomfort, but sometimes weren’t that noticeable. (6) I was unable to have a bowel movement on days 1 (afternoon/evening after morning surgery), 2, and 3. By day 3, I was feeling the need to have a bowel movement, but couldn’t. If this happens to you, don’t worry too much. The surgery, the anesthetic, the stent, and the meds you’re taking all slow down your bowels. Don’t push hard either ! I ate a couple of prunes on day 3. Finally on day 4, I had two bowel movements. These were a little difficult, but they happened. I was nervous to go, thinking I might dislodge the stent. But I was ok. (7) The day of surgery, and days 2 and 3, I leaked some blood into my undershorts. No blood on day 4.
IMPORTANT: Drink lots of water ! Maybe some apple juice and a little cranberry juice too ! Mostly water though ! When you pee, if you don’t have a good stream going, and there’s not much to pee out, I found that it hurts much worse through the stent. Better to have a good stream of urine.
Tomorrow- day 5, I am supposed to pull the string and remove the stent myself. I don’t know what to expect. I’m going to stand in the shower and try to pull it out. I’m taking pain meds beforehand. I’m hoping I won’t be in for more urethra pain like I had right after the surgery.
I just removed my stent myself this morning. After reading different posts from others I stood in the shower, hesitated for a few minutes, then started to pull the string. I had urine come out (no blood that I saw) and kept pulling slowly. Eventually I saw the white tubing and started pulling a little faster. No pain whatsoever. However a tingling or discomfort from the tubing exiting. Whole ordeal took maybe 30 secs after I started the pulling. I took two Ibuprofen and two Pyridium that I was prescribed after because I still had a slight feeling of needing to urinate. The stent is roughly between 10″-12″ long. Wish you the best removing it.
I’ve had 76 kidney stones since I was 16, I am now 39. The first 2 that I had I were removed, I will NEVER have them removed again. Sadly, my daughter has been cursed with the kidney stone lineage…that being said, she had one removed and had a stint. When she went for her follow up, the nurse removed the stint without checker her file; it was WAY to early. Of course, my daughter was EXTREMELY sick and had to be re-admitted to the hospital. The doctor won’t give a straight answer but, I’ve known him for years and can see that he was VERY concerned about her. What were the dangers of the stint being removed too early?
Its really nice to have more information about procedures. Realy i had a stone which was in upper ureter which had moved to lower ureter after taking medicine now i had undergone urs surgery & have a dj stend to be removed after 21 days i am scarred about pain now i have pain while urinating in back side from lkidney upto bladder i am in rest with more intake of water 250 ml per 45 minutes. Ooutput is within 10 to 15 minutes now i am worried will it be the same i am on complete bed rest for 2 weeks.
I had my stent removal on Jan 6,2015 and 2 days later and I am fine. It was scary getting it out in the office and hard to relax. The most I can say about it was it felt like a baby moving in my belly…It’s truly a miracle that it didn’t hurt because thee whole while it was in – I peed blood every day, i felt it, hurt so bad that I wanted to rip it out myself ( no string) It was the worst thing ever!!! I am having a 24 urinalysis done to see what is causing the stones so I can change my diet and maybe never have stones again!!!!
i had a kidney stone in my left uterus and was removed on the 20th and a stent placed, can any one let me know how the stent is removed, did they use any anesthesia or not
Went ER w/fever 103.8° body aches, and headache, was told its flu. Went back 3 X last ER visit I said we are missing something! I was grasping for any clue, I said maybe i have diverticulitis? So they scanned me and found the left ureter blocked and kidney swelling 3X normal size. Emergency surgery to place stent 3days in hospital for iv antibiotics. After 2 weeks w/ stent back to surgery to laser stone and change stents. This new stent has strings I’ve accidently tugged them and it is no fun. Thank you all for the posts I’m so worried about pulling the stent Sat. The first stent was tolerable but
This one with strings is making me crazy. I get tired s easily. And my bladder spasms if the strings move at all. Was going to try to work tommorow but note if i can stay focused or sit 8 hrs.
Stent have been removed on 19th October 2014. After that I’m not feeling O.K. Nothing is coming out through my penis after intercourse. Is this normal after stent operation or not? Some one please inform about it.
Thanks
Amin
I too have the similar problem,
I just had surgery on Monday to remove stone and place stent. I had to laugh when I read the post about not wanting to drink anything bc it hurt ..I was the same way. .next day it was much better. The bladder spasms is what was getting me, I couldn’t get comfortable the day after surgery. I am Much better today still a little uncomfortable but I can tolerate. It was nice to read some of your posts and say ahh ok I have that or feel that. Thanks for sharing your stories.
I have an 8 mm stone that i had blasted twice now and it still did not break up. I go in on Dec 23 to have it removed and a stent put in. (Merry Christmas to me.) Reading these comments have helped to put my mind at ease. Thanks
I had the surgery done on Wednesday, December 17th. The surgery (Cystoscopy w/left Ureteroscopy with Holmium Laser and left stent and left Retrograde) itself is not so bad. You will be put to sleep for 45 minutes as the surgery takes about 30 minutes. The doc will leave a stent inside your Ureter for a week. Every time you urinate, you will feel a burning and pain in you left side down to your penis, even if you take the pain pills. The pain pills will only help you rest. When you awake and have to go urinate again, you will feel the pain all over again. The stent is the cause of all this pain. I’m scheduled to have the stent removed on Christmas Eve. I’m sure once the stent comes out there will be more pain that follows the stent removal. Maybe the pain pilss will work for the stent removal.
I just had my second stent removed, first one not knocked out for. I was petrified, losing sleep and visibly shaking this morning in the office. I don’t handle pain well and this whole experience has been crazy (large stones in both kidneys, 3 surgeries total and 2 stents).
I took a pain pill and 2 Aleve an hour or so before my appt. In the room I was literally crying, tears streaming down my face in fear.
They first applied the lidocaine and after a few minutes my doctor came in and started by inserting the scope into place. He told me the reason it can be painful is bc your reflexes tense up and cause the bladder to spasm so he gave me specific directions for how to breathe when. It only burned a teeny amount as I took my 5 second breath in. After that I got to watch on the screen as they use these little clamps to grab the end of the stent (0 sensation during this part). And then more breathing while he slowly pulled it out on a long breath in. There was burning for the first few seconds and then after that nothing for the last 2/3 of the pulling the rest of the way out. I was elated when I saw that thing was out of my body. 🙂
So that’s my story. My best advice is have a great experienced doctor if possible, try not to worry if you can but if you can’t you can’t, take a pain pill + Aleve if you can get a ride to and from the appt, and really focus on your breathing and take nice deep slow yogic breathing style breaths when they tell you to. It will be over before you know it!
So far I have had no cramping pain and its been about 2 hours since I left the doctor. I took 1 more pain pill in the car on the way home just in case but so far so good. I believe the Aleve might have stopped the residual spasms from happening.
Good luck everyone! And it really isn’t as bad as all the Google stories make it out to be.
Thank you for your comments. It was very helpful. Just got my stent put in Friday, January 2 and have to have it for four weeks. But I am worried about it coming out too, it doesn’t sound like it would feel good. I will try not to worry based on your recommendation and definitely probably take pain pills before I go.
Thank you. I will take a pain pill. I am told I am ok to go into work after. I sit most the day and work advertising sales. My stint has been in 4 weeks. Without the string. Back in mid December they put me in the hospital overnight and did the Lithotripsy procedure, ( sorry about the spelling )
Hi everyone, had my kidney stones removed on wed afternoon…is it normal feeling like i did a thousand situps..stent all ok
Had bilateral stents placed today. One 9mm stone in right side and 7mm stone in left. I have stents in both and I am miserable. I’m scared to potty because I end crying in pain. I’ve got to deal with thus for 7 days. I feel for any one that has to endure this. I’ve had kidney stones off and in since I was 17, I am now 44.
i had three stones removed on monday nov 3, and a stent was put in… they told me i could remove it on friday nov 7…. i’m a little apprehensive, but i think if i can stand the pain of kidney stones, surely i’ll be able to endure through this.. thanks to everyone for sharing your experience of your stents
Finally had my stent out! That thing hurt like I had a stone the entire time it was in…They removed two stones that were 3ml long. I couldnt pass them on own, and it took about 6hrs tuesday the 28 of October to pee. A little bit after I had the worst pain in back and now a few blood spots
im going in sunday morning 2nd nov 14 to have my stent out its only been in since the 14th jan 14 its been a right pain making wanna pee all the time without notice let hope they dont cancell again nearly 11 months is well over due fingers crossed
Hello had surgery to have 8 mm stone out. Had stent in no fun for 1 st day I felt like peering myself. Went in had stent out in office no problems. About 2 hours later sharp pain in Kindey for a while..
I have had 7 ureter stents in for the last 21 months. It gets replaced every 90 days. I have ovarian cancer and the largest tumor has been pressing on the ureter not allowing for proper urination. My cancer is inoperable so chemotherapy has been shrinking the tumor. Both my urologist and my oncologist feel we can try to remove the stent to see how I do. The removal will be next Wed….I am soooooo excited to think of finally being able to live without this thing. Only 2 out of the 7 stents have been pain free. 5 of them have caused me pain every day. You do get used to it but it is tiring. I will let you know on this board how the removal goes! YEAH!
I just had my stent put in today, doc was able to remove the 8ml stone while inserting the stent so atleast thats out of the way, except I have to say I have never felt sooooooo mcuh pain while urinating, I fell like Im peeing razer blades. Im afaid to drink water because I dont want to urinate 🙁 I soo hope that in 3 days when I remove the stent it wont hurt as bad as I’m feeling when urinating. Doc said I will prob have some pain meds before they pull it out to lessen the uncomfortable feeling. I so wish they could put me to sleep as I believe it will not be just a weird feeling being that I will have it removed so soon. Anyways thanks all for the post’s as I did see some of you had an ok experience with the removal process. Wish me Luck :=)
peeing razors will only last a short time- try pouring water over your area when you pee the first few times- I had four stents only the first time was bad- trust me- it gets easier every time. Had a 4.8 mm stone- then graduated to a self removable stent. You be okay – the first day is the worst!!!
I’ve just had a sent put in yesterday. The first couple of times urinating was very painful then I was told to sit and put my head down between my legs when on the toilet. Hey presto, pain free!
The string had gone back up just inside “the tip” as the Dr called it. Still had to have the lube squirted in and had to use the scope but not very far in. The thing felt like a dock rope being pulled out for just about two or three seconds but that was it. I kept it to remind me of what happens when I don’t drink enough water. I have bottled water sitting in every room and every vehicle except the Harley now.
do you always have to have a kidney stent removed
Yeah just removed my stents myself, no problems, a little uncomfortable but no pain. Thank God no way as bd as it sounds.
I just had my stent removed n I feel do much pain is there anything that I can do to stop the pain?
I took Prednisone & Nifedipine when trying to pass the kidney stone. Theoretically, I took these to make the stone’s passage through the ureter & urethra easier. I also had a stent inserted.
So my question is: Is it possible that taking one tablet of each of these sometime before I remove my stent make the removal process a little easier?
I’ve gotta admit, I’m not looking forward to removing that thing, even though everyone says it’s uncomfortable but not painful. I’m sure it’s mainly just a mindset thing, but when I have to do it in seven days, I will not be a happy camper.
I just pulled my stent out (5 days after stone removed). They had the one with the string so I could take it out myself. I took a muscle relaxer & Aleve one hour before I took it out. I peed, put a towel on my bed, laid down & slowly removed it. It was about 12″ long. The entire time I was pulling it out, urine was coming with it. I couldn’t stop during the procedure, I wanted it out, now! So I soaked my bed beneath the towel. I recommend you put plastic wrap, or a bag underneath if you are doing this procedure at home. It was not painful. It was uncomfortable. I had to remind myself the entire 1-2 minutes I was pulling, to relax. It was not a terrible thing. Hopefully the bloody urine will now stop.
Hope this helps someone. Wish I’d read this before I did it. No one said anything about urine leaking out during the entire removal.
Thank you so much PE…I have to remove my stent tomorrow morning…the hospital pretty much just told me to “pull it out”……no other instructions! Thanks again!!
Thank you! This was very helpful 🙂
Thanks so much. Just had stent put in today. Doctor told my husband how to remove it while I was in recovery. A little discomfort but nothing compared to the pain I was in. Had a 6mm stone imbedded in my ureter. Am already peeing normal again after maybe 4 times of bloody urine. Had to have stent in because ER I went to dropped the ball. By the time I got to urologist after being told at ER it would pass, I was septic. Luckily my urologist could get me in. She even came in after her grandmother died to do my surgery. Gotta say she’s a angel. First night in over 2 weeks I got to eat real food & am not feeling like someone is stabbing my side. Thanks for the advice I remove my stent in 6 days.
Had kidney stone blockage and had to go for surgery. Stone was 7 plus mm . It all depends on the doctor. Mine with blasted July 10th and I went to office where he removed the stent on the 17th. Never took pain meds. No problem whatsoever and no pain when he removed it, A tiny uncomfortable was all. No problem with stent either.Hope all of you don’ t panic about stent removal.