What to Expect After Ureteral Stent Placement

Most people experience noticeable urinary discomfort, flank pain, and changes in daily routine after a ureteral stent is placed. In one study tracking stent patients, roughly 78% reported bothersome urinary symptoms and more than 80% said stent-related pain affected their daily activities.¹ These numbers sound alarming, but the symptoms are well-documented, generally manageable, and temporary. Understanding what is normal, what is not, and what you can do about it makes the experience significantly less distressing.

The Symptoms Most People Experience

The most common complaints fall into a few clusters: urinary urgency and frequency, a burning or stinging sensation during urination, blood in the urine, and pain in the flank or lower abdomen. In the same study, the urinary symptoms that patients found most bothersome included storage symptoms (the constant feeling you need to go), incontinence episodes, and visible blood in the urine.¹ Some degree of hematuria, especially after physical activity, is expected and usually harmless as long as you can still urinate and the urine is not thick with clots.

Pain tends to concentrate in two places. One is a dull ache in the kidney area on the side where the stent sits, often worse when your bladder is full or right after you urinate. The other is a sharp discomfort low in the pelvis, near the bladder. Many people describe a sudden, intense urge to urinate that comes on without warning, followed by pain at the tip of the urethra during or after voiding. These sensations are among the most distressing aspects of having a stent, and they can feel alarming the first few times, but they do not mean something has gone wrong.

Why the Stent Causes So Much Discomfort

The stent is a thin, flexible tube that runs from your kidney down to your bladder, coiled at both ends to keep it in place. That lower coil sits inside the bladder, and every time the bladder contracts or fills, it rubs against the coil. This mechanical irritation is thought to be the primary driver of the urgency, frequency, and burning that stent patients experience. Reflux of urine back up through the stent toward the kidney, along with transmission of higher-than-normal pressures during voiding, likely explains the flank pain.² In plain terms, each time you bear down to urinate, some urine gets pushed back up through the stent toward the kidney, creating a pressure wave you feel as a sharp ache.

Several factors make the discomfort worse for some people than others. A study examining what drives stent-related pain found that a urinary tract infection, the lower end of the stent crossing to the opposite side of the bladder, placement of the upper coil in a calyx rather than the renal pelvis, and longer time with the stent in place were all associated with significantly more discomfort.³ You have no control over most of these, but knowing that a UTI makes everything worse is useful: if your symptoms suddenly spike or you develop a fever, it is worth getting a urine culture rather than assuming it is just the stent being the stent.

The stent also moves with you. Imaging studies have shown that the kidney-end coil shifts downward by about 2.5 cm on average when you stand up from lying down, and the bladder coil moves roughly 2.3 cm vertically with changes in position.⁴ This constant shifting explains why certain activities or even just rolling over in bed can trigger sudden twinges.

How It Affects Work, Sleep, and Sex

The impact on daily life goes beyond bathroom trips. Among stent patients in a widely cited quality-of-life study, about 58% reported reduced work capacity and a negative economic impact, and roughly a third reported sexual dysfunction.¹ Another prospective study following patients after ureteroscopy confirmed that general health, work performance, and sexual activity were all affected by having a stent in place.⁵

Sleep disruption is one of the less-discussed but most consistent complaints. The urinary frequency does not stop at night. Getting up three or four times to urinate is common, and the urgency can be intense enough to wake you from deep sleep. Many people find that sleeping on the side opposite the stent and keeping a glass of water nearby (staying hydrated actually helps dilute the urine and reduce irritation) makes the nights more tolerable.

Sexual activity can be painful, especially for men, who sometimes experience discomfort at the tip of the penis during or after ejaculation. For women, deep pelvic discomfort during intercourse is reported. These symptoms resolve after the stent comes out, but knowing they are normal prevents unnecessary worry while the stent is in place.

Medications That Help

Your doctor may prescribe medications to take the edge off stent symptoms, and the evidence suggests certain drugs genuinely help. The most studied class is alpha-blockers, particularly tamsulosin (often sold under the brand name Flomax). A systematic review and network meta-analysis pooling data from multiple trials found that both tamsulosin and alfuzosin lowered urinary symptom scores and body pain scores compared to placebo, with tamsulosin ranking highest for both measures.⁶ In a prospective trial, patients not receiving tamsulosin had markedly worse urinary symptom and pain scores at one week after stent placement compared to those who took it.⁷

Alpha-blockers work by relaxing smooth muscle in the bladder neck and lower ureter, which reduces the spasms that cause much of the urgency and pain. They do not eliminate symptoms entirely, but most patients who take them report needing fewer painkillers. One trial found that patients on tamsulosin or mirabegron (a different type of bladder-relaxing drug) used fewer analgesic doses than those on placebo, with mirabegron slightly outperforming tamsulosin in painkiller reduction. Tamsulosin also lowered urinary symptom scores compared to the control group.⁸

For patients whose symptoms are dominated by that constant urgency and frequency, anticholinergic drugs and mirabegron (a beta-3 agonist) have shown benefit specifically for the irritative bladder component.⁹ There is also growing evidence that combining an alpha-blocker with an anticholinergic may be more effective than either drug alone.¹⁰ If stent-related sexual dysfunction is particularly bothersome, some research points toward phosphodiesterase-5 inhibitors (the same class as drugs used for erectile dysfunction) as helpful for that specific symptom domain.¹⁰

Beyond prescriptions, practical measures help. Drink plenty of water throughout the day; concentrated urine is more irritating. Avoid heavy lifting and vigorous exercise during the stenting period, as these can increase blood in the urine and trigger more pain. Over-the-counter pain relievers like ibuprofen are often the first-line approach for breakthrough discomfort, though your doctor may prescribe something stronger if needed.

When to Call Your Doctor

Some symptoms cross the line from expected nuisance to potential complication. Fever is the biggest red flag. A prospective study of over 600 stented patients found that about 7% developed a febrile urinary tract infection related to the stent, and roughly one in five of those patients progressed to sepsis or septic shock.¹¹ The most commonly responsible bacteria was E. coli, followed by Enterococcus species. A temperature above 101°F (38.3°C) with a stent in place warrants prompt medical evaluation, not a wait-and-see approach.

Other warning signs include inability to urinate at all (which could indicate the stent has migrated or a clot is blocking flow), severe uncontrolled pain despite medication, heavy bleeding that produces large clots or makes the urine opaque red, and sudden worsening of symptoms weeks into the stenting period, which could signal a new infection or stent migration. Nausea and vomiting that prevent you from keeping fluids down also merit a call, since dehydration makes everything worse and can be dangerous with compromised kidney drainage.

The Forgotten Stent Problem

One of the more sobering aspects of ureteral stents is what happens when they stay in too long. Stents are meant to be temporary, typically remaining in place for days to a few weeks, though some clinical situations call for longer durations. The trouble begins when patients forget about the stent or fail to return for removal. A systematic review of the medical literature on “forgotten” ureteral stents found a mean dwell time of over 33 months in reported cases, with some stents left in place for decades. The most common reason? Patient-related factors like poor follow-up compliance, simple forgetfulness, and misunderstanding about whether the stent needed to come out, which accounted for about 84% of cases.¹²

Forgotten stents are not just an academic curiosity. The consequences can be severe. In those same cases, encrustation (mineral buildup on and around the stent) occurred in about 81% of patients, and urinary tract infections in about 40%.¹² Removing a heavily encrusted stent often requires multiple procedures rather than the simple office cystoscopy used for a timely removal. The review found that nearly 60% of patients with forgotten stents needed multiple or multimodal procedures to achieve a stent-free state.¹²

Encrustation develops because any foreign body continuously exposed to urine becomes coated with a bacterial film that then calcifies over time.¹³ Factors that accelerate this process include UTIs, a history of kidney stones, chronic kidney disease, and simply time.¹⁴ The message is straightforward: do not miss your stent removal appointment. Set a phone reminder, write it on the calendar, tell someone close to you. Some urology practices have begun using smartphone apps to send reminders and track stent patients, and in a pilot study, no patients using one such app experienced forgotten stents or stent-related readmissions.¹⁵

What Stent Removal Is Like

For most patients, stent removal is quick and performed in the office. A thin, flexible cystoscope is inserted through the urethra, and the doctor grasps the lower coil of the stent and pulls it out. The whole process typically takes under a minute. It is uncomfortable, sometimes sharply so, but the discomfort is brief. Some doctors apply a local anesthetic gel before the procedure; others do not. It is reasonable to ask in advance what your doctor’s approach is.

Some stents are placed with an extraction string, a thin thread that trails from the bladder out through the urethra so you can pull the stent out yourself at home on the scheduled day. A randomized trial comparing patients with and without extraction strings found no difference in stent-related quality of life, pain at the time of removal, or complications like infections or emergency visits between the two groups.¹⁶ In other words, having a string does not make the stent experience worse, and self-removal at home appears to be just as safe as office cystoscopy. Some patients find the string irritating where it exits the urethra, but most adapt within a day or two.

After the stent comes out, expect your symptoms to improve rapidly but not instantly. Many people feel a significant reduction in urgency and pain within 24 to 48 hours. Some residual irritation, mild blood in the urine, and occasional urgency can linger for a few days to a week as the ureter and bladder recover from the irritation. Rarely, temporary swelling in the ureter after stent removal can cause a brief flare of flank pain, but this usually resolves on its own.

How Stents Compare to the Alternative

When the kidney needs to be drained, doctors have two main options: an internal ureteral stent or a percutaneous nephrostomy tube (a tube inserted through the skin of the back directly into the kidney). The choice depends on the clinical situation, but patients understandably wonder which is more tolerable. The comparison is not as clear-cut as you might expect.

A prospective study from two centers found that stent patients initially had more urinary discomfort, while nephrostomy patients had more trouble with mobility and personal hygiene (the external tube and drainage bag are cumbersome). Overall quality-of-life scores were similar at first. Over time, however, the nephrostomy patients’ symptoms improved while the stent patients’ symptoms stayed about the same, translating to higher overall quality-of-life scores for the nephrostomy group at the later time point.¹⁷

A systematic review and meta-analysis echoed this pattern. The two methods were equally effective for decompressing an obstructed kidney, with no significant difference in failure rates or post-procedural pain. Patients with nephrostomy tubes did have lower rates of blood in the urine and painful urination afterward, though they spent slightly more time in the hospital.¹⁸ When patients who had experienced both types of drainage were asked which they preferred, a study of malignant obstruction cases found that the large majority chose the stent, likely because there is no external bag and fewer restrictions on clothing and bathing.¹⁹ Neither option is pain-free, and each involves a different set of trade-offs in daily life.

Stent Design and Where Things Are Headed

If stents are so universally uncomfortable, you might wonder why they have not been redesigned to fix the problem. Researchers have been trying for years. Stent engineering has explored softer materials, different coil shapes, drug-eluting coatings that release medication locally, and surface coatings designed to resist bacterial biofilm and mineral buildup.²⁰ Some biodegradable stents have been developed that dissolve on their own, eliminating the need for a removal procedure and the risk of a forgotten stent altogether.

Progress has been real but incremental. The fundamental challenge is that any tube running from the kidney to the bladder will irritate the bladder lining to some degree, and any tube exposed to urine will eventually attract mineral deposits. The stents in widespread clinical use today are considerably better than the rigid devices used decades ago, but the gap between “tolerable” and “comfortable” has proven hard to close. Encrustation and biofilm formation remain the two most persistent engineering obstacles, and reviews of the field consistently note that more work is needed on both fronts.²⁰ For now, the best available strategy is short dwell times, symptom management with medication, and timely removal.

Keeping Track of Your Stent

One practical development worth knowing about is the growing use of digital tools to help patients manage the stent period. Smartphone apps designed for stent patients can send removal-date reminders, provide personalized guidance on symptoms, and offer a line of communication with the urology team without requiring an office visit. In a study using one such app during the pandemic-era lockdowns, when routine follow-up was disrupted, no patients experienced a forgotten stent or a stent-related readmission.¹⁵ Another study found that interactive counseling through a mobile app improved patient knowledge about their stent, with particularly high satisfaction among older patients who might otherwise feel left in the dark about what is happening and why.²¹

Whether or not your clinic uses an app, the principle matters: stay organized about your stent. Know the date it went in, the date it should come out, and who to call if something feels wrong. Keep a brief log of your symptoms so you can tell your doctor whether things are stable or getting worse. And if your symptoms suddenly escalate weeks into the stenting period, do not assume it is normal wear and tear. Worsening symptoms with a stent that has been in place for a while can signal infection or early encrustation, and catching those early makes the resolution much simpler.