A ureteral stent is a thin, flexible tube temporarily placed inside the ureter, the muscular tube connecting the kidney to the bladder. The primary purpose of this device, often called a double-J stent, is to ensure urine can drain freely from the kidney into the bladder. This drainage is necessary when the ureter is blocked, most commonly due to kidney stones, or when swelling occurs after a surgical procedure.
The stent prevents urine backup into the kidney, which can lead to severe pain, infection, or long-term damage to the organ. Since these devices are not intended to remain indefinitely, their removal is a planned, necessary step once the underlying condition is resolved and the ureter has healed.
Preparing for Stent Removal
The first step involves confirming the exact duration the stent needs to remain in place, which is determined by the treating physician and can range from a few days to several months. Adhering strictly to the scheduled removal date is important, as leaving a stent in too long increases the risk of encrustation, which can complicate the extraction process.
In the hours leading up to the removal appointment, you may be instructed to take specific medications, such as an alpha-blocker, to help relax the ureter and bladder muscles. Physicians often recommend drinking three to four cups of water about 30 minutes before the procedure; this helps fill the bladder and can make the removal more comfortable. If the removal is performed using only a local anesthetic gel, you typically do not require a ride home, but confirm this detail with your care team.
The Two Methods of Stent Removal
The method for removing the ureteral stent depends on whether a retrieval string was left attached during insertion. The urologist determines which method is appropriate based on the length of time the stent has been in place and the specific clinical circumstances. Both procedures are brief and generally well-tolerated.
String Removal
When a stent has a retrieval string attached, it extends out through the urethra and is usually taped securely to the thigh or abdomen. This method is the least invasive and can often be performed by the patient at home, or by a nurse in a clinic setting, under direct instruction from the physician. Patients typically qualify for this option when the stent is temporary and only needed for a short period, such as less than a week following a minor procedure.
To perform the removal at home, it is often recommended to sit in a bathtub or shower to relax the pelvic floor muscles. The process involves a steady, gentle pull on the string until the entire tube, which is approximately 10 to 15 inches long, slides out. Only attempt this on the date specified by your physician, and immediately contact your doctor if the string breaks or if the stent does not appear to be fully intact upon removal.
Cystoscopic Removal
For stents without an external string, or those that have been in place for a longer duration, the removal requires a cystoscopy procedure performed in a clinical or hospital setting. This method involves the use of a flexible, thin tube called a cystoscope, which is inserted through the urethra into the bladder. Before insertion, a local anesthetic gel is applied to the urethra to provide numbing and lubrication.
The cystoscope has a small camera that allows the physician to visualize the coiled end of the stent inside the bladder. Once the stent’s coil is located, a fine instrument is passed through the cystoscope to grasp the stent. The physician then gently pulls the instrument, removing the entire stent along with the cystoscope. This entire procedure is quick, often lasting only one to three minutes, and typically does not require general anesthesia or sedation.
Recovery and Immediate Post-Removal Symptoms
Following the successful removal of the ureteral stent, it is common to experience immediate side effects as the urinary tract adjusts to the absence of the foreign object. These symptoms are temporary, and most patients report improved comfort compared to when the stent was in place.
You may experience an immediate, temporary increase in the urgency and frequency of urination, along with a burning sensation, medically known as dysuria, during the first few voids. Some patients also note a mild ache or cramping in the lower abdomen or flank, which is caused by the bladder contracting and the ureter briefly spasming. These symptoms are typically mild and often subside within 24 to 48 hours of the removal procedure.
It is normal to observe light hematuria, or a pink-tinged discoloration in the urine, for a few days after the stent is removed. Maintaining a high fluid intake throughout the day helps flush the bladder and minimize any burning sensation. While most discomfort is manageable with over-the-counter pain medication, you must monitor for specific symptoms that require immediate medical attention.
Contact your physician or seek emergency care if you develop a fever exceeding 101.5 degrees Fahrenheit, experience severe pain that is not controlled by medication, or are completely unable to urinate. The presence of large blood clots in the urine, or persistent nausea and vomiting, are also serious signs indicating a potential complication that requires urgent evaluation.