A ureteral stent is a thin, flexible tube temporarily placed inside the ureter, the duct that carries urine from the kidney to the bladder. This device ensures that urine can drain freely, often following a procedure like kidney stone removal or to bypass an obstruction. When a stent is placed for short-term use, a fine string or tether is sometimes left attached to the end, extending outside the body through the urethra to simplify the removal process. Finding that this visible removal string has vanished can cause immediate concern, but this scenario is a relatively common occurrence following stent placement.
Why the Stent String Retracts
The disappearance of the external string is usually the result of normal physical dynamics within the lower urinary tract. The bladder, a muscular organ designed to expand and contract, can experience spasms as it fills and empties, especially when irritated by the stent. These involuntary contractions physically tug on the removal string, drawing the exposed portion inward through the urethra and into the bladder.
This retraction means the string is simply resting inside the bladder, pulled back by muscle activity. In other instances, slight upward migration of the entire stent within the ureter can cause the string to retreat out of sight. Although less common, the string may also break or be accidentally snagged and pulled out entirely, requiring medical notification. These events are generally an issue of convenience for removal rather than a sign of a complication with the stent itself.
Immediate Actions and When to Seek Urgent Care
The most important initial response upon noticing the string has disappeared is to remain calm and immediately contact the urology office or the surgeon who placed the stent. Healthcare providers are accustomed to this situation and will schedule the necessary procedure to retrieve the stent on the planned date. It is imperative that no attempt is made to probe, fish for, or manually retrieve the string, as this carries a high risk of accidentally pulling the stent out or displacing it, which can injure the ureter.
While the retracted string itself is not an emergency, certain severe symptoms indicate a need for immediate medical attention. Seek care right away if you develop a fever higher than 101.5°F or chills, which signals a serious urinary tract infection. Other urgent warning signs include severe pain not alleviated by prescribed medication, a complete inability to urinate, or a sudden increase in blood with large clots in the urine. These symptoms suggest a potential blockage or complication that requires prompt evaluation.
Retrieval Methods for Stringless Stents
When the external string is unavailable for removal, the standard procedure is a flexible cystoscopy performed by a urologist. This is a brief, minor, outpatient procedure typically performed in the doctor’s office or a specialized room. To minimize discomfort, a local anesthetic gel is first applied to the urethra, acting as both a lubricant and a numbing agent.
The physician gently inserts a flexible cystoscope—a thin, lighted tube with a camera—through the urethra and into the bladder. This allows the urologist to visually inspect the bladder lining and locate the coiled end of the stent. Once visualized, the doctor passes a specialized instrument, such as grasping forceps, through the scope’s working channel.
The forceps are used to securely grasp the coil of the stent inside the bladder. The urologist then gently pulls the entire stent out through the urethra, often removing the stent and the cystoscope simultaneously. This procedure is quick, often taking only a few minutes, and patients usually return home shortly thereafter. Timely removal is a priority, as stents left in place too long can become encrusted with mineral deposits, making later retrieval more complex.