A stent is a small, mesh, or plastic tube inserted into a body passageway to keep it open and maintain the flow of fluid or blood. Whether a stent can be removed depends on its purpose, material, and location. Some stents are designed for permanent placement, acting as long-term structural supports. Others are temporary measures intended to allow healing or resolve an acute blockage. Determining if the device is meant to remain indefinitely or if scheduled removal is required is the first step in a treatment plan.
Permanent vs. Temporary Stents
The primary difference between stent types is their intended duration of placement, which dictates whether removal is possible or necessary. Most vascular stents, such as those placed in coronary arteries, are permanent fixtures. These devices are typically made of metal alloys and mechanically prop open a narrowed or blocked artery wall.
Over time, the artery’s inner lining grows over the metallic framework, integrating the stent into the vessel wall. Removing an integrated permanent stent poses a high risk of damaging the artery, causing a tear, or triggering a blood clot. Therefore, the stent is left in place after restoring blood flow to prevent the return of a blockage, known as restenosis.
An exception is the development of bioresorbable scaffolds, which are temporary devices that dissolve completely over two to three years. These scaffolds provide initial support and then disappear, leaving behind a healed artery that can naturally pulsate and dilate. This eliminates the long-term presence of a foreign object, but the patient must be monitored closely during the bioabsorption period.
Temporary Stents That Require Removal
Temporary stents are used in non-vascular systems when a blockage or narrowing needs resolution, but long-term support is not required. The most common example is the ureteral stent, often called a double-J stent, placed between the kidney and the bladder. This thin, flexible tube bypasses obstructions, such as kidney stones, or ensures urine drainage after surgery.
Prolonged placement of these temporary stents can lead to complications. The stent material can become encrusted with mineral deposits, similar to kidney stones, making removal difficult. Other temporary stents include plastic biliary stents that drain the bile duct or esophageal stents placed during healing from a stricture. Once the underlying medical issue is resolved, these devices are scheduled for removal to prevent complications.
The Timing and Rationale for Removal
The timing for temporary stent removal is specific, determined by the organ system, stent material, and medical reason for placement. For ureteral stents, the typical duration is a few days to several weeks, with a maximum recommended time of three months before replacement. This schedule prevents encrustation, which can begin forming as early as six weeks and complicates retrieval.
The rationale for removal is that the stent’s purpose has been achieved. For a ureteral stent placed after kidney stone removal, it is removed once post-operative swelling subsides and urine can flow normally. If the stent treats a stricture or obstruction caused by an external mass, it may need to remain longer or be replaced periodically.
Urgent removal is required if complications arise, such as migration, severe pain, infection, or fever. In these cases, the risk of leaving the stent outweighs the benefit, and a prompt procedure is scheduled. The goal of removal is to conclude the temporary intervention and allow the body to function without the device.
The Removal Procedure and Patient Recovery
The procedure for removing a temporary stent is typically minimally invasive and performed on an outpatient basis. For a ureteral stent, the most common method is cystoscopy. A physician inserts a thin, flexible tube with a camera (cystoscope) through the urethra and into the bladder. A grasping instrument is then passed through the cystoscope to secure and pull the stent out.
The procedure is usually brief, often taking only a few minutes, and uses a local anesthetic gel to numb the urethra. Some short-term ureteral stents are placed with a string attached that extends outside the body. This allows the patient to remove the device themselves at home under guidance. This self-removal method is quick and involves only a moment of discomfort.
Following removal, patients can often resume normal activities immediately, though temporary side effects may occur. It is common to notice a burning sensation during urination or traces of blood in the urine for a day or two. Drinking plenty of fluids is encouraged during recovery to flush the urinary system and alleviate discomfort.