How Serious Is Having a Kidney Stent Put In?

Having a ureteral stent placed is one of the most common procedures in urology, and the placement itself is typically quick and low-risk. But the experience of living with the stent afterward is a different story. Somewhere between half and 80 percent of patients report bothersome symptoms while the stent is in place, ranging from bladder irritation and flank pain to effects on sleep, work, and sexual function. The procedure is not “serious” in the way open surgery is, but it can be genuinely disruptive, and the complications that arise from stents left in too long or managed poorly can become very serious indeed.

What a Ureteral Stent Actually Does

A ureteral stent is a thin, flexible tube placed inside the ureter, the narrow passage connecting a kidney to the bladder. Its main job is to keep urine flowing when something is blocking or threatening to block that passage. That blockage might come from a kidney stone, swelling after surgery, a tumor pressing on the ureter, or scar tissue narrowing the channel.¹ The stent has a small curl at each end, one anchored in the kidney and one sitting in the bladder, which is why it’s sometimes called a “double-J” or “pigtail” stent.

The reasons for placing one vary widely. After ureteroscopy for kidney stones, stents help the ureter heal without swelling shut. In cancer patients, they can maintain drainage when a tumor compresses the ureter. In kidney transplant recipients, they protect the freshly connected ureter while it heals. The clinical scenarios are diverse, but the principle is the same: keep the urine moving.²

What the Placement Procedure Involves

Stent placement is usually done with a cystoscope, a thin camera passed through the urethra into the bladder. From there, the stent is threaded up into the ureter under imaging guidance, most often fluoroscopy (a type of real-time X-ray). The whole thing can take as little as five to fifteen minutes. Many people assume it requires general anesthesia, but a growing body of evidence shows it can be done safely under local anesthesia in an office or bedside setting.

In local-anesthesia placements, lidocaine gel is typically applied to the urethra and sometimes instilled into the bladder before the procedure begins. A flexible cystoscope and guidewire are used to position the stent, and its placement is confirmed with an X-ray or fluoroscopy image immediately afterward.³ A systematic review found that lidocaine jelly was the primary anesthetic used across studies, with fluoroscopic guidance employed in about 86 percent of cases.⁴ When the stent is placed during a procedure you’re already under anesthesia for, like ureteroscopy for a kidney stone, you won’t feel the placement at all. The discomfort starts later.

The Symptoms Most People Experience

This is where the reality of stents diverges sharply from what many patients expect. The placement procedure itself is manageable. Living with the stent is the hard part. Estimates of how many people experience bothersome symptoms range from about 50 to 80 percent, depending on the study and how “bothersome” is defined.⁵

The most common complaints fall into a few categories:

• Bladder irritation: urgency, frequency, and a burning sensation during urination. In a large dataset of over 50,000 stent procedures, irritative bladder symptoms appeared in about a third of cases.⁶
• Pain: typically in the flank or kidney area, often worsening during urination or physical activity. One prospective study found that over 83 percent of patients complained of pain, and in over 90 percent of those, the pain interfered with everyday life.⁷
• Blood in urine: mild hematuria is very common and usually not dangerous, though it can be alarming if you’re not expecting it. One review noted hematuria in about 54 percent of patients.⁸

What makes stent discomfort tricky is that the exact mechanism isn’t fully understood. The leading theory involves two factors working together: the lower curl of the stent physically irritates the bladder wall, and the stent creates an open channel that allows urine to reflux backward from the bladder up toward the kidney. That reflux transmits pressure to the kidney, which is likely responsible for the flank pain many patients feel, especially when they urinate or strain.⁹ The discomfort isn’t a sign that something has gone wrong. It’s a predictable consequence of having a foreign object bridging two organs that are sensitive to pressure and touch.

When Complications Become Genuinely Serious

For most patients, stent symptoms are unpleasant but manageable and temporary. The serious complications are less common but deserve attention because some of them can become dangerous.

Infection is the most significant risk. Bacteria adhere to the stent surface and form a biofilm, a sticky layer that’s extremely difficult for the immune system or antibiotics to penetrate. Once a biofilm establishes itself, it can seed urinary tract infections that are harder to treat and more likely to recur.¹⁰ In the worst cases, bacteria from the urinary tract enter the bloodstream, causing urosepsis, which carries a high mortality rate in severely affected patients. This is rare, but it’s the reason urologists monitor stented patients for signs of infection and generally aim to remove the stent as soon as it’s no longer needed.

Evidence from kidney transplant recipients illustrates the infection timing well. In one study, UTIs that occurred while the stent was still in place were far more likely to be complicated, associated with bacteria in the bloodstream, and to require hospitalization compared to infections diagnosed after stent removal. Removing the stent earlier cut the rate of stent-related UTIs roughly in half.¹¹

Encrustation is the other major concern. Over time, minerals from urine deposit onto the stent surface, essentially forming a crust. The longer the stent stays in, the more encrustation builds up. This process is influenced by how long the stent has been in place, the patient’s own stone-forming tendencies, and the biofilm that bacteria create on the stent surface.¹² A moderately encrusted stent can still be removed with cystoscopy. A heavily encrusted one can require multiple procedures, including stone-breaking techniques, to extract.

The Forgotten Stent Problem

One of the most preventable yet surprisingly persistent problems in urology is the “forgotten” stent: a stent that’s left in place far longer than intended because the patient missed a follow-up, wasn’t clearly told when to come back, or simply fell through the cracks of a busy healthcare system. The consequences can be severe.

A systematic review found that the most common presenting complaints when a forgotten stent is finally discovered are flank pain, lower urinary tract symptoms, and blood in the urine. By that point, encrustation has occurred in about 80 percent of cases, and UTIs are present in about 40 percent. More than half of these patients require multiple procedures, often involving sophisticated stone-breaking techniques, to get the stent out.¹³ Another study found that about 62 percent of forgotten-stent cases needed more than a simple cystoscopy to remove, with some patients requiring open surgery or multiple sessions over weeks.¹⁴

If you have a stent placed, the single most important thing you can do is know your removal date and keep that appointment. Some clinics now use automated reminder systems because the consequences of a forgotten stent are so well documented and so avoidable.

How Stents Affect Daily Life and Work

Beyond the physical symptoms, stents can take a real toll on quality of life. An early but influential study found that over 80 percent of patients reported stent-related pain affecting daily activities, about 58 percent reported reduced work capacity with a negative economic impact, and roughly a third reported sexual problems.¹⁵

Not everyone experiences the same severity, though. A qualitative study that interviewed patients in depth after ureteroscopy found that the experience split into distinct groups: about a third had minimal impact on daily living, while roughly a fifth experienced substantial disruption across sleep, mood, work, exercise, and social activities. The rest fell somewhere in between, with some daily activities moderately affected while others remained relatively normal.¹⁶ Predicting in advance who will fall into which group is difficult, which is part of what makes the experience stressful: you won’t know how much it will bother you until the stent is in.

Effects on Sexual Function

This is an aspect that patients often don’t hear about beforehand. A systematic review and meta-analysis found that sexual function scores declined significantly in both men and women while a stent was in place.¹⁷ Symptoms can include pain during intercourse, erectile difficulties in men, and reduced arousal or loss of orgasm in women.¹⁸

The reassuring finding is that these effects appear to be temporary. A real-world observational study measured sexual function scores on the day of stent removal and then four weeks later. Both men and women had significantly reduced scores while stented, but by four weeks after removal, scores returned to baseline.¹⁹ If your doctor hasn’t mentioned this, it’s worth bringing up, partly so you know what to expect and partly so you aren’t alarmed by symptoms that will resolve.

Medications That Help With Stent Discomfort

You don’t have to just grit your teeth through it. Several drug classes have been studied for stent-related symptoms, and the evidence for a couple of them is reasonably strong.

Alpha-blockers, medications originally developed for prostate issues, relax smooth muscle in the ureter and bladder neck. A network meta-analysis found that both tamsulosin and alfuzosin lowered stent-related symptom scores compared to placebo, with tamsulosin ranking highest in effectiveness.²⁰ A more recent meta-analysis that included additional drug classes found that solifenacin, an antimuscarinic that targets bladder overactivity, may be the most effective single medication. Tamsulosin ranked second, and alfuzosin also showed benefit. Combining an alpha-blocker with an antimuscarinic appeared to outperform either drug alone.²¹ A trial studying exactly that combination (tamsulosin plus solifenacin) confirmed that the combination group had the greatest symptom improvement.²²

If your stent symptoms are significantly affecting your daily life, it’s worth asking your urologist about these medications rather than assuming discomfort is just something to tolerate.

What Stent Removal Feels Like

Removal is typically quick but can be uncomfortable. There are two main approaches: office cystoscopy, where the doctor inserts a scope and grabs the stent with a small grasper, or string removal, where an extraction string left dangling from the urethra after placement is pulled by the patient or doctor at the scheduled time.

A survey of patient experiences found that mean pain during removal was about 4.8 out of 10, with 57 percent reporting moderate-to-severe pain. Removal by cystoscopy was the most painful method, with an average score of 5.3. About a third of patients reported delayed severe pain after removal, and 9 percent returned for emergency care.²³ String removal, at least for men, appears to be significantly less painful than cystoscopic removal. One controlled trial found mean pain scores of about 2.7 for string removal versus 5.7 for cystoscopy, though the difference was mainly driven by reduced urethral pain in men.²⁴

There’s a trade-off, though. An earlier randomized trial found no significant difference in quality of life while the stent was in place between patients with and without an extraction string, and string patients had comparable rates of UTIs and emergency visits to those without strings.²⁵ Strings can occasionally cause irritation or anxiety during the dwell time. In other words, string removal is gentler at the end but comes with its own minor nuisances while the stent is in.

Emergency Visits After Stent Placement

One underappreciated aspect of having a stent is how often it leads to an unplanned trip to the emergency department. A statewide surgical collaborative found that stent placement after ureteroscopy was associated with about 25 percent higher odds of an emergency department visit compared to not being stented.²⁶ Another study found that roughly 20 percent of stented patients had an emergency visit or hospital admission within 120 days of a stone procedure, with the majority returning for urinary complaints.²⁷

These visits are usually for symptoms like pain, bleeding, or suspected infection rather than life-threatening emergencies. But they reflect a real gap between what patients are told to expect and what they actually experience. Structured preoperative education, where a clinician walks you through the likely sensations and a realistic recovery timeline, has been shown to reduce anxiety and even perception of pain. Patients who understand what’s coming tend to cope better, even when the physical experience is the same.²⁸

Stents Versus Nephrostomy Tubes

When the urinary tract needs emergency drainage, particularly from infection or severe obstruction, doctors choose between an internal ureteral stent and a percutaneous nephrostomy, an external tube placed through the back directly into the kidney. Patients sometimes wonder which is “better,” and the answer depends on what you mean by better.

A systematic review and meta-analysis found no significant difference between the two approaches in terms of infection control, failure rates, pain levels, or pain medication use. However, patients with nephrostomy tubes had less blood in their urine and less bladder irritation afterward, while those with stents experienced significantly more irritative urinary symptoms.²⁹ A prospective study added nuance: stent patients had more urinary discomfort while nephrostomy patients had worse symptoms related to mobility and personal hygiene (an external tube taped to your back is its own burden). Over time, nephrostomy patients’ symptoms improved while stent patients’ symptoms stayed relatively flat, giving nephrostomy patients an edge in overall quality of life at later follow-up.³⁰

Neither option is clearly superior across the board. A quality-of-life survey found no significant overall difference in health utility between the two groups, though stent patients reported more irritative symptoms and nephrostomy patients needed more help with daily tube care.³¹ In practice, the choice often comes down to clinical factors like how sick the patient is, whether retrograde access is feasible, and what equipment and expertise are available.

Stents During Pregnancy

Kidney stones during pregnancy are uncommon but can be a genuine emergency because the usual workhorse imaging tool, CT scans, involves radiation. When a pregnant patient needs drainage, the two options are a ureteral stent or a nephrostomy tube. Both appear to be safe for the pregnancy itself. A meta-analysis found that the rate of normal fertility outcomes with ureteral stent therapy was about 99 percent, with premature birth and abortion rates below 1 percent for both stent and nephrostomy approaches.³²

A large propensity-matched analysis found no difference in rates of premature labor, premature rupture of membranes, or C-section between the two approaches. Where stents did show an advantage was in the months following placement: stented patients had about half the rate of subsequent UTIs or pyelonephritis, fewer emergency department visits, and fewer repeat procedures compared to those with nephrostomy tubes.³³ For pregnant patients, the stent’s internal placement and lower infection rate may tip the balance in its favor.

Where Stent Technology Is Headed

Much of the discomfort, encrustation, and infection risk associated with stents comes down to materials. Traditional stents are made from polymers like polyurethane or silicone, and researchers have spent years trying to improve on them. Current work focuses on two main fronts: coatings that resist bacterial adhesion and biofilm formation, and entirely biodegradable stents that dissolve on their own so removal becomes unnecessary.³⁴

Biodegradable stents are an especially appealing concept because they would eliminate the forgotten-stent problem entirely and spare patients the discomfort of a removal procedure. Several materials are under investigation, including various polymers that break down predictably in urine.³⁵ Anti-bacterial and anti-encrustation coatings are further along in development, with some already in clinical use and others showing promise in laboratory testing.³⁶ Fully biodegradable stents that dissolve at a predictable, controllable rate are still largely in the research phase, but the field is moving steadily in that direction. If you end up needing a stent a decade from now, the experience could look quite different from what patients go through today.