Ureteral Stent Placement and Removal

This card describes ureteral stents, the temporary tubes often used around stone procedures: why one may be placed, what living with it can feel like, and how it comes out. It is general education for patients, families and students, and the treating urologist decides whether a stent is right in a given case. Related cards include ureteroscopy, percutaneous nephrolithotomy and the stone procedures overview.

What it is

Cleveland Clinic describes a ureteral stent as a thin, flexible tube of silicone or polyurethane that holds the ureter open so urine can flow from the kidney to the bladder. It is about 10 to 15 inches long and about a quarter inch across. The top end has a coil that sits in the kidney, and the bottom end has a loop that sits in the bladder, which helps keep the stent in place. Other names are ureteric stent and double-J stent. It lies completely inside the body, so there is no bag to collect urine, unlike a nephrostomy tube, which drains the kidney through the skin.

Why it is done

Cleveland Clinic says providers place stents to prevent or treat blockages of the ureter. For stones, the common reasons are letting urine bypass a stone that slows or stops flow, preventing a new blockage after stone treatment, and preventing a blockage from swelling after stone removal. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes a temporary stent after ureteroscopy as a way to drain urine while swelling goes away, and says a stent may also be left after other stone procedures to help urine flow or a stone to pass.

MedlinePlus notes that a stent may be placed before or after shock wave lithotripsy until stone pieces pass, and after percutaneous kidney procedures so the kidney can heal.

How it is done, in outline

Cleveland Clinic says stenting is usually done in a hospital or surgical center under general anesthesia and takes less than 30 minutes, guided by imaging such as fluoroscopy or ultrasound. The urologist passes a cystoscope through the urethra into the bladder, threads a thin guidewire into the blocked ureter, uses the wire to place the stent, and then removes the wire and scope.

Recovery

Cleveland Clinic describes some blood in the urine and general discomfort, especially when urinating, as normal at first, improving over a few days, although traces of blood may come and go for as long as the stent is in. NIDDK describes pain, discomfort in the kidney or bladder area, and frequent or urgent urination, saying the discomfort is generally mild but can last for the whole time the stent is in place.

For pain, Cleveland Clinic says over-the-counter anti-inflammatory medicines can help for people who can take them, and a provider may prescribe tamsulosin for stent pain. It suggests avoiding strenuous activity for at least a few days, including lifting more than about 10 pounds.

How long a stent stays varies. NIDDK says a few days to a week or more. Cleveland Clinic says most stay for a few days up to a few weeks, and that people who need one for months or years have it replaced every three to six months. MedlinePlus describes a return visit at 1 or 2 weeks after ureteroscopy.

Some short-term stents have a string that hangs outside the urethra, and a provider gently pulls it to remove the stent. Stents without a string are removed in a minor office procedure: a numbing agent is applied, a cystoscope is passed into the bladder, and small clamps grasp the stent (Cleveland Clinic). MedlinePlus says this can usually be done in the office without anesthesia. Many people feel moderate discomfort after the numbing wears off, usually for a few days.

Cleveland Clinic advises calling a healthcare provider about clots of tissue in the urine, dark, cloudy or foul-smelling urine, trouble urinating or severe pain or burning, kidney pain, nausea and vomiting, or signs of infection such as fever or chills. Its ureteroscopy page adds a stent that falls out as a reason to call, and an inability to urinate for six hours as a reason to go to an emergency room. NIDDK lists severe bleeding or pain, an inability to urinate with a full bladder, and fever.

Risks

Cleveland Clinic says up to 80% of people with stents have one or more complications, including bladder irritation, bladder spasms, urinating more than usual, blood in the urine, pain or burning when urinating, urinary tract infection, and a stent that becomes blocked, broken or dislodged. It explains that the looped end can rub on the bladder wall as the bladder shrinks during urination, one reason some people feel more pain than others. The same source says an untreated ureteral blockage may lead to life-threatening kidney failure or sepsis, and calls stents generally safe, without typical long-term problems.

Questions to ask your clinician

• Why do I need a stent, and how long is it expected to stay in?
• Does my stent have a string, and who will remove it?
• When and where will the stent be removed, and will I need anesthesia?
• Which symptoms are expected with a stent, and what can I take for discomfort?
• Which symptoms mean I should call you or go to an emergency room?