Most ureteral stents are removed in one of two ways: you pull them out yourself at home using an attached string, or a urologist retrieves them in a brief office procedure using a thin camera called a cystoscope. Either method takes only a few minutes, and while the sensation ranges from mildly uncomfortable to briefly sharp, serious complications from the removal itself are uncommon. What catches many people off guard is what happens afterward: roughly two-thirds of patients report some combination of pain, blood in the urine, or urinary urgency in the days following removal, and those symptoms can linger longer than expected.
String Removal at Home
If your stent was placed with an extraction string, you already have the simplest removal option. The string is a thin thread attached to the lower end of the stent, threaded through the urethra, and taped to your inner thigh or the tip of the penis (or near the urethral opening in women). When the time comes, you wash your hands, sit on the toilet, and pull the string steadily and firmly until the entire stent slides out. Most people describe a tugging sensation and a brief wave of discomfort, but the whole process is over in seconds.
Self-removal with a string works well for the vast majority of patients. In one study of nearly 100 patients who attempted it, about 95% removed the stent successfully on their own without needing to return to the clinic. Complication rates between the string and no-string groups were essentially the same, around 13-14%.
A meta-analysis pooling data from multiple trials confirmed that string removal caused significantly less pain than cystoscopic removal and also shortened the total time the stent stayed in, since patients could take it out at home on the scheduled date instead of waiting for an office appointment. Infection rates and emergency room visits were no different between the two approaches. The one trade-off is a small risk of premature dislodgement: if you snag the string by accident, the stent can shift out of position before it is supposed to come out, which sometimes means a return trip to the operating room.
Cystoscopic Removal in the Office
When there is no string, a urologist removes the stent using cystoscopy. You lie back on an exam table, a local anesthetic gel is applied to the urethra, and a thin flexible or rigid scope is threaded into the bladder. The doctor locates the curled end of the stent, grasps it with a small tool passed through the scope, and pulls it out. The procedure typically takes under five minutes.
For many patients, the anticipation is worse than the reality, though the discomfort is real. The scope passing through the urethra can cause a burning or pressure sensation, and you may feel a strong urge to urinate during the procedure. A trial comparing rigid and flexible cystoscopes for stent removal in young men found that using a flexible scope produced significantly lower pain scores and higher satisfaction. In a larger European study evaluating a single-use flexible cystoscope across 83 procedures, all but five stents were removed successfully; the failures involved stents that had become encrusted or had migrated further up the ureter, requiring a more involved procedure.
You do not routinely need antibiotics for a standard cystoscopic stent removal. A randomized controlled trial found that no patients in either the antibiotic or no-antibiotic group developed a urinary tract infection within a month of the procedure, and a separate cohort study reached the same conclusion. Your urologist may still prescribe antibiotics if you have specific risk factors, but for an uncomplicated removal, skipping them appears safe.
What Removal Actually Feels Like
Pain during the procedure itself depends on the method. With string removal, the discomfort is brief and self-limited. With cystoscopy, the local lidocaine gel numbs the urethra, but the scope and the act of pulling the stent through the bladder neck still register as uncomfortable pressure and a stinging sensation. One study found that adding tramadol to the standard lidocaine gel before cystoscopic removal significantly reduced pain compared to lidocaine alone. Another randomized trial reported that listening to binaural beats through headphones during the procedure lowered both anxiety and pain scores compared to silence, suggesting the psychological component of the experience is not trivial.
If you are especially anxious, it is worth mentioning this to your urologist ahead of time. Some offices offer mild oral sedation or a short-acting anxiolytic, though this is not standard practice for a quick stent pull. Distraction techniques and controlled breathing are low-cost strategies that genuinely help.
What to Expect in the Days After Removal
This is where the experience surprises most patients. A study tracking over 100 patients after stent removal found that 64% had symptoms afterward, and among those who were symptomatic, 60% reported pain or discomfort as the primary complaint. Blood in the urine, urinary frequency, urgency, and occasionally a low-grade fever round out the list of common post-removal symptoms.
The pain tends to be worst in the first day or two. Some people describe it as a dull ache in the flank or lower abdomen, while others experience sharp cramping similar to the renal colic that may have brought them to the urologist in the first place. This happens because pulling the stent out can trigger ureteral spasm and leave behind mild inflammation and swelling in the ureter’s lining. In most cases the discomfort fades steadily over three to five days, though a minority of patients have symptoms that persist for a week or longer.
Urinary symptoms, particularly the frequent and urgent need to urinate, are also common and can take several days to settle. Daily quality-of-life surveys collected from patients in a large stent outcomes study showed that urinary symptoms peaked the day after surgery, stayed elevated for the entire time the stent was in, and did not fully resolve until after the stent was removed. For most people, the bothersome urinary urgency improved within a few days of removal, but wide variation from person to person was a consistent finding.
Managing Pain Before and After Removal
The single most effective thing you can do is take an anti-inflammatory painkiller before the procedure. A randomized, double-blind trial found that 55% of patients experienced severe pain after stent removal when given a placebo, and a single dose of an NSAID beforehand prevented that severe pain. Ask your urologist whether you should take ibuprofen, naproxen, or a prescription-strength NSAID about an hour before your appointment. If you cannot take NSAIDs due to kidney issues or stomach problems, acetaminophen is a reasonable alternative, though the evidence for it in this specific setting is less robust.
For the days following removal, a combination approach works best. One trial tested an NSAID (diclofenac) plus tamsulosin, a medication that relaxes the smooth muscle in the ureter, and found the combination provided better pain relief over the first two days compared to either drug alone or placebo. Tamsulosin is normally prescribed for prostate issues, but it also eases the passage of urine through a swollen ureter, which is why urologists sometimes prescribe it around the time of stent removal regardless of your gender.
Staying well hydrated helps flush out any small blood clots and reduces the concentration of urine passing over irritated tissue. Warm baths or a heating pad on the flank can ease cramping. If your pain escalates rather than improves after the first 48 hours, or if you develop a fever above 101°F, call your urologist. Worsening symptoms can signal a ureteral obstruction from swelling or a urinary tract infection that needs treatment.
Medications That Help While the Stent Is Still In
For many patients, the worst part of the stent experience is not the removal but the days or weeks of living with the device. The constant urge to urinate, bladder spasms, and flank pain with physical activity are the most common complaints. If your stent will be in place for more than a few days, your doctor may offer medications to ease these symptoms while you wait for removal.
Mirabegron, a bladder-relaxing drug, has emerged as one of the better-studied options. A randomized controlled trial found that patients taking mirabegron had significantly less daytime frequency, nighttime urination, urgency, and both flank and abdominal pain compared to those given no medication. Analgesic use and overall quality-of-life scores were also better in the mirabegron group. A systematic review and meta-analysis confirmed that mirabegron improved urinary symptom scores across multiple independent studies. A head-to-head comparison of mirabegron, tamsulosin, and solifenacin (another bladder-relaxing drug) found mirabegron superior to both alternatives for urinary symptoms, sexual function scores, and work performance during the stenting period.
Alpha-blockers like tamsulosin are the other commonly prescribed option and have been used for this purpose for longer. They work differently, relaxing the ureteral and bladder neck muscles rather than calming the bladder wall itself. Many urologists prescribe tamsulosin as a first-line choice because of long familiarity, but the newer evidence suggests mirabegron may be a better option, particularly if tamsulosin causes side effects like dizziness or nasal congestion.
Timing Matters More Than You Think
Your urologist will typically schedule stent removal somewhere between five days and several weeks after surgery, depending on the reason the stent was placed and whether any complications arose. The timing is not arbitrary. A large study of patients who had ureteroscopy and stent placement found that those whose stents were removed within four days or fewer had a higher risk of ending up in the emergency department around the time of removal. The researchers recommended a minimum dwell time of five days for patients who did not already have a stent in place before surgery.
An earlier pilot study comparing three-day and seven-day stent durations after ureteroscopy found that the shorter duration was associated with worse outcomes in terms of post-operative events and flank pain. The takeaway is that pulling a stent out too early can cause more problems than leaving it in a few extra days. If you are eager to get the stent removed ahead of schedule because of discomfort, talk to your urologist about symptom management in the interim rather than pushing for premature removal.
On the other end, leaving a stent in too long carries its own risks. Stents left in well beyond their intended removal date can become encrusted with mineral deposits, develop bacterial biofilms, or even fragment. A systematic review of forgotten ureteral stents found that the average time a stent was left in place before someone noticed was over 33 months, with cases extending up to 32 years. The most common reason was simply that the patient forgot or mistakenly believed the stent would dissolve on its own. Encrustation was found in about 80% of forgotten stents, and infections occurred in roughly 40%. Removing a forgotten, encrusted stent often requires multiple procedures rather than a simple office visit.
When Stents Get Forgotten
The forgotten-stent scenario sounds improbable, but it is a well-documented problem in urology. Patient-related factors account for the large majority of cases, including poor follow-up compliance, memory lapses, and the misconception that the stent is permanent or self-dissolving. Some patients move, change doctors, or lose track of their care plan after the initial surgery, and the stent quietly remains in their body.
Symptoms of a forgotten stent typically include flank pain, lower urinary tract symptoms like frequency and urgency, and blood in the urine. A study of 68 patients with forgotten stents found that about a quarter had visible encrustation on imaging and 13% had a fragmented stent. Only about 38% of these cases could be managed with a simple cystoscopic removal; the rest required more complex interventions including ureteroscopy, percutaneous kidney access, or shock-wave lithotripsy to break up the mineralized deposits before the stent pieces could be extracted. Longer stent durations were associated with higher rates of urinary tract infection.
Stent fracture, while rare, is one of the more dramatic complications of prolonged indwelling time. Polyurethane stents, the most commonly used type, can spontaneously break apart after extended exposure to urine, leaving fragments lodged in the ureter or kidney that require surgical retrieval. The best prevention is straightforward: keep your follow-up appointment, set a reminder on your phone, and make sure someone in your life knows you have a stent that needs to come out.
Magnetic Stents and the Future of Removal
One of the more interesting developments in stent technology is the magnetic-tipped stent, which can be retrieved in the office using a specialized catheter with a magnetic tip rather than a cystoscope. A meta-analysis of randomized controlled trials comparing magnetic and conventional stents found that magnetic stent removal took significantly less time and caused substantially less pain, with average pain scores roughly 2 to 3 points lower on a standard scale. Another systematic review confirmed the pain reduction and noted that magnetic removal was also cheaper because it eliminated the need for cystoscopy equipment and the associated procedural costs.
The magnetic approach has limitations. It requires the stent to be in good position and not encrusted, and it is not yet universally available. Some patients report that the indwelling discomfort is similar to a conventional stent, meaning the benefit is concentrated at the moment of removal rather than during the entire stenting period. Still, for patients who dread the cystoscopy step, the magnetic option is a genuine improvement when available.
Looking further ahead, biodegradable ureteral stents aim to eliminate the removal step entirely. Made from materials designed to dissolve in urine over a predictable timeframe, these stents would spare patients both the discomfort of removal and the risk of forgetting. The concept has attracted growing interest from researchers, and early prototypes using materials like magnesium-yttrium alloys show promise in laboratory studies. Clinical adoption is still years away, but the direction is clear: the ideal stent is one you never have to think about again.
How Much Stents Affect Daily Life
The impact of a ureteral stent on daily activities varies enormously from person to person. In a qualitative study that conducted in-depth interviews with stent patients, researchers categorized the experience into three groups. About a third of participants fell into a “minimal impact” group, reporting that the stent barely affected sleep, mood, work, exercise, or social activities. Roughly half fell into a “moderate” group, where some activities were substantially disrupted while others were barely touched. And about a fifth experienced substantial disruption across nearly every domain of daily life, including work, childcare, exercise, and sleep.
This wide variation is one of the frustrating aspects of stent placement: your urologist cannot predict in advance how much the stent will bother you. A validated questionnaire designed specifically to measure stent-related quality of life captures domains including urinary symptoms, body pain, general health, work performance, and sexual function. Scores change significantly between the stenting period and after removal, confirming what patients report anecdotally: life gets meaningfully better once the stent is out. If you are in the group that finds the stent profoundly disruptive, knowing that this is a recognized and common experience, not a sign that something has gone wrong, can itself be reassuring.
Physical activity during the stenting period is generally safe but may increase discomfort. Most urologists advise avoiding heavy lifting and high-impact exercise while the stent is in place, not because of injury risk to the stent itself, but because vigorous movement tends to worsen flank pain and bladder spasms. Walking, light stretching, and gentle daily activities are usually well tolerated. After removal, you can typically return to your normal exercise routine within a few days, once the post-removal soreness subsides. If you had a kidney stone procedure, your surgeon may have separate activity restrictions related to the surgery itself that extend beyond the stent removal date.