How Long Does Pain Last After Ureteral Stent Removal?

For most people, the worst pain after ureteral stent removal fades within 24 to 48 hours. But that timeline hides a lot of individual variation. Roughly a third of patients report delayed severe pain after the stent comes out, and about one in ten end up back in the emergency room because of it. How much you hurt and for how long depends heavily on how the stent is removed, whether you took certain medications beforehand, and factors like your sex and anxiety level.

What to Expect in the First Day or Two

The removal itself is brief but uncomfortable. When done by office cystoscopy — the most common method, involving a small scope through the urethra — patients rate the pain of the procedure at about 5.3 on a 10-point scale.¹ But the pain doesn’t necessarily stop when the scope is withdrawn. A study of 104 patients found that 64% developed symptoms after stent removal, and among those who had symptoms, 60% experienced pain or discomfort.² About a third of all patients reported delayed severe pain — meaning pain that arrived hours after they left the clinic — and 9% sought emergency care for it.¹

In a small randomized trial, over half of the placebo group experienced severe pain (a score of 7 or higher out of 10) within the first 24 hours after removal.³ So the honest answer is: for most people, 24 to 48 hours covers the worst of it. But the first day can be surprisingly intense without pre-medication, and a meaningful minority have pain that sends them back to the hospital.

How the Stent Comes Out Makes a Big Difference

There are three main ways a ureteral stent gets removed: office cystoscopy, pulling it out via an attached extraction string, or using a newer magnetic retrieval system. The method you end up with can roughly halve the amount of pain you experience.

String Removal vs. Cystoscopy

When stents are placed with an extraction string — a thin thread that hangs outside the body — you or your doctor can pull the stent out without a scope. A meta-analysis of randomized trials found that string removal reduced pain by about 2.5 points on a 10-point scale compared to cystoscopic removal.⁴ An individual trial reported the difference even more starkly: patients who had string removal scored an average of 2.7 for pain versus 5.7 for cystoscopy.⁵

The benefit may not be equal between sexes, though the data is genuinely contradictory. The meta-analysis found that women had a clear pain reduction with string removal while men did not.⁴ A single trial found the opposite — men benefited more.⁵ Researchers haven’t settled this, so it’s not something you can plan around.

One trade-off worth knowing: string removal was associated with more emergency room visits than cystoscopy in one study.¹ The string can cause irritation while the stent is still in place, or it can dislodge early, sending patients for urgent care.

Magnetic Stents

Magnetic ureteral stents have a small magnet at the bladder end, allowing retrieval with a magnetic catheter tip instead of a full cystoscope. Two separate meta-analyses found that magnetic stent removal caused roughly 2.7 to 3 points less pain on a 10-point scale compared to conventional stent removal.⁶⁷ Removal time was also much shorter. These stents aren’t yet universally available and tend to cost more, but the pain reduction is substantial.

Pre-Medication Can Prevent Severe Pain

One of the most striking findings in this area is how effective a single dose of an anti-inflammatory drug can be. In a randomized trial, none of the patients who received an NSAID before stent removal experienced severe pain in the following 24 hours, compared to 55% of those who got a placebo.³ That’s not a modest benefit — it essentially eliminated severe post-removal pain in that study. The mechanism is straightforward: removing the stent triggers ureteral spasm and local inflammation, and an anti-inflammatory blocks both.

A trial testing tamsulosin (an alpha-blocker that relaxes smooth muscle in the ureter), diclofenac sodium (an NSAID), and the combination found that the combination outperformed either drug alone. Pain scores were significantly lower in the combination group for the first two days after removal.⁸

On the emergency-visit front, ketorolac (another NSAID, given by injection) also showed a practical benefit: it reduced unplanned ER or clinic visits for renal colic after stent removal from 13% to just 2%.⁹

Medications for While the Stent Is Still In

If you’re dealing with pain and urinary symptoms before the stent is removed, that’s worth managing too, partly because stent-related discomfort during indwelling can predict worse pain after removal. Antimuscarinic drugs like solifenacin and trospium were found to be the most effective for bothersome urinary symptoms while a stent is in place, with the addition of an alpha-blocker like alfuzosin helping specifically with nighttime urination.¹⁰

A more recent comparison found that tadalafil (a PDE5 inhibitor usually prescribed for erectile dysfunction) actually outperformed tamsulosin across most symptom categories, including pain, during the weeks a stent was in place. The combination of tamsulosin and solifenacin gave the broadest overall symptom relief across urinary discomfort, work functioning, and other quality-of-life measures.¹¹ These options are worth raising with your urologist if stent symptoms are significantly affecting your daily life.

Who Tends to Hurt More

Data from an international prospective registry found that men reported lower pain scores than women.¹² Women have shorter urethras, and stent-related bladder irritation tends to be more pronounced. The same registry found no significant difference in pain based on a patient’s height relative to stent length or whether the stent had a tether.

What happened during the original procedure also matters. Patients whose stones were removed using a basket during ureteroscopy had more pain after stent removal, likely reflecting more ureteral trauma from the initial surgery. The same study found that patients who reported more discomfort while the stent was indwelling also tended to have more pain after it came out.² Your in-stent experience, in other words, is a decent predictor of your post-removal experience.

Anxiety and the Comfort Factor

Pre-procedure anxiety has a well-documented relationship with how much pain you perceive during and after urological procedures. A randomized trial testing a comfort-oriented removal protocol — which included measures to reduce anxiety — cut 24-hour pain scores roughly in half compared to conventional removal (about 2.6 vs. 5.5 on a 10-point scale).¹³ That’s a bigger difference than many drug interventions achieve.

In another trial, patients who listened to binaural beats (a type of auditory stimulation) during stent removal reported significantly lower pain scores and anxiety levels than control groups. Classical music helped too, though not as much.¹⁴

One thing that did not help was watching an informational video beforehand: a separate trial found identical pain scores — 5.7 out of 10 — whether or not patients watched an educational video before the procedure.¹⁵ Knowing what to expect may ease worry conceptually, but it didn’t translate to less pain. Actively calming the nervous system during the procedure seems to matter more than information alone.

Does Stent Duration Affect Post-Removal Pain?

You might assume that the longer a stent sits in your ureter, the worse it hurts when it comes out. The evidence is surprisingly contradictory. A trial comparing stent removal at 3 days versus 7 days after ureteroscopy found that the 3-day group reported less pain, fewer urinary symptoms, and better general health scores after removal.¹⁶

But another study found the opposite: longer indwelling stent duration was associated with less pain after removal.² And a large international registry detected no significant difference in pain scores between different indwelling time groups at all.¹²

One way to make sense of this: very short durations may leave the ureter still actively healing from surgery, so removal adds insult to injury. Very long durations may allow the ureter to fully accommodate the stent, making removal less jarring. In the broad middle ground, duration may not matter much at all. Your doctor’s decision about when to pull the stent is driven by the clinical reason it was placed, not pain optimization, and that’s the right priority.

When Pain Signals Something More Serious

Some post-removal pain is expected. But certain patterns warrant a call to your doctor or a trip to the emergency room. Fever is the clearest red flag. A study of children who had stents placed after pyeloplasty found that about 7.5% developed a febrile urinary tract infection after stent removal, with the most common culprits being Enterococcus and E. coli bacteria that colonized the stent surface.¹⁷ While that study involved pediatric patients, UTIs after stent removal happen in adults as well.

Other warning signs include pain that is getting worse rather than better after the first 24 hours, inability to urinate, heavy or persistent blood in the urine (light blood-tinged urine for a day or two is common and usually harmless), and chills or shaking. The roughly 9% emergency room return rate reflects mostly renal colic — intense, cramping flank pain caused by ureteral spasm or swelling after the stent comes out. It’s painful and alarming but usually resolves with anti-inflammatory medication and hydration.

Practical Steps Before and After Removal

Bringing together what the research consistently shows, a few things can meaningfully change your post-removal experience:

Ask about pre-medication: A single NSAID dose before the procedure can dramatically reduce severe pain in the first 24 hours. Diclofenac or ketorolac are common choices, and combining an NSAID with an alpha-blocker like tamsulosin may work even better.
Discuss removal method: If your stent has an extraction string, removal will likely hurt less than cystoscopy, though there are trade-offs to discuss with your urologist. Magnetic stents may be available at some centers.
Manage anxiety actively: Comfort measures during the procedure — music, relaxation techniques, or sedation options — translate directly into lower pain scores. Simply watching an educational video does not.
Plan for the first day: Expect discomfort, urgency, and possibly some blood in your urine for a day or two. Stay hydrated, keep anti-inflammatory medication available if your doctor approves, and avoid strenuous activity.
Know when to call: Fever, worsening pain beyond 24 hours, inability to urinate, or heavy bleeding are reasons to contact your doctor promptly.

Newer Stent Technologies

Magnetic stents are the most studied advance, but they aren’t the only direction. Drug-eluting stents, which slowly release anti-inflammatory or analgesic medication directly into the ureter wall, are being investigated as a way to reduce both indwelling discomfort and post-removal symptoms. Biodegradable stents that dissolve on their own — eliminating the removal procedure entirely — are another area of active research, though they have not reached widespread clinical use and still face challenges with predictable dissolution rates and maintaining adequate drainage throughout their lifespan. For now, the combination of a well-chosen removal method, pre-medication with an NSAID, and attention to anxiety management gives most patients the best shot at keeping post-removal pain brief and tolerable.