Ureteral Stent Self-Removal by Patients
Patients should not remove their own ureteral stents unless specifically designed for self-removal with an attached string and explicit instructions from their urologist. 1
Proper Stent Management
Ureteral stents are commonly used medical devices that ensure urinary drainage and relieve obstruction, pain, and infection during urologic procedures. However, their management requires careful medical supervision to prevent serious complications.
Standard Removal Process
- Ureteral stents should typically be removed by healthcare professionals via cystourethroscopy in a clinical setting
- Only stents specifically designed with a "dangle string" attachment can be safely removed by patients at home 2
- Patient surveys indicate that when given options, patients prefer either:
- Removing their own stents via dangle strings at home
- Undergoing cystoscopic removal in the operating room with some form of anesthesia 2
Timing of Stent Removal
Stents should be removed as soon as clinically appropriate to minimize complications:
- Uncomplicated cases: 2-3 weeks
- Maximum duration for most clinical scenarios: 3 months 1
- Specific clinical scenarios:
- Partial ureteral lesions: 2-3 weeks (after confirmed healing)
- Complete ureteral transection with repair: 4-6 weeks
- Ureteral reimplantation: 2-4 weeks
- Temporary obstructions (stones/pregnancy): 2-4 weeks after obstruction resolves
- Malignant obstruction: requires regular exchanges every 3 months 1
Risks of Improper Stent Management
Complications of Prolonged Stent Retention
Leaving stents in place beyond recommended timeframes can lead to serious complications:
- Encrustation and stone formation
- Infection and sepsis
- Hematuria
- Hydronephrosis
- Stent fragmentation (10% of cases)
- Stent migration (8.2% of cases) 3
Case Reports of Forgotten Stents
Several case reports highlight the dangers of forgotten or improperly managed stents:
- An 88-year-old man with a stent left in place for 6 years developed significant calculi formation requiring holmium laser lithotripsy for removal 4
- A 43-year-old woman with a forgotten stent for over 25 years developed huge encrustation, requiring laparoscopic nephroureterectomy 5
- Approximately 32.7% of ureteral stents require removal due to late complications 3
Management of Retained or Encrusted Stents
When stents are retained or become encrusted, removal becomes significantly more complex:
- Patients may require an average of 2.7 endourologic procedures
- Multiple approaches may be needed:
- Cystolitholapaxy (for distal encrustation)
- Percutaneous nephrolithotomy
- Antegrade or retrograde ureteroscopy with lithotripsy
- Extracorporeal shockwave lithotripsy 6
Best Practices for Stent Management
- Close follow-up of stented patients is essential for early detection of complications
- Patients with comorbidities (diabetes, renal failure, immunocompromised status) may require more vigilant monitoring 1
- Stent registry systems, proper patient education, and regular follow-up are critical to prevent complications 5
In conclusion, ureteral stent removal should be performed by healthcare professionals unless specifically designed for self-removal with proper instructions. The risks of improper stent management, including encrustation, infection, and the need for complex interventions, make professional management the safest approach for most patients.