How long is a ureteral stent typically left in place?

Ureteral Stent Duration Guidelines

Ureteral stents should be removed as soon as possible, typically within 2-3 weeks for uncomplicated cases, and no longer than 3 months for most clinical scenarios to minimize complications. 1

Standard Duration Guidelines by Clinical Scenario

The recommended duration for ureteral stents varies based on the specific clinical indication:

• Uncomplicated ureteroscopy: 2-3 days appears sufficient 2, though traditional practice has been up to 1 week
• Partial ureteral lesions: 2-3 weeks, with removal once healing is confirmed 1
• Complete ureteral transection with repair: 4-6 weeks 1
• Ureteral reimplantation: 2-4 weeks 1
• Temporary obstructions (stones or pregnancy): 2-4 weeks, removed after resolution of the obstruction 1
• Extraperitoneal bladder injuries: 2-3 weeks with catheter drainage 1
• Ureterovaginal fistula: Initial placement for 2-3 weeks, possibly longer if healing is incomplete 1

Long-Term Stenting Considerations

For patients requiring long-term stenting (such as those with malignant obstruction):

• Regular stent exchanges are required every 3 months 1
• Prolonged stent duration significantly increases complication risks 3, 4

Complications of Extended Stent Duration

Research shows significant complications with prolonged stent placement:

• A prospective study found that 32.7% of ureteral stents had to be removed due to late complications 3
• Only 8% of stented renal units could maintain stents for 12 months without requiring change 4
• Common complications requiring stent change include:
  • New-onset flank pain (35%)
  • Increased serum creatinine (30%)
  • New or increased hydronephrosis (30%) 4
  • Stent fragmentation (10%)
  • Stent migration (8.2%) 3

Recent Evidence on Shorter Stent Duration

Recent research supports shorter stent duration when possible:

• A 2024 study demonstrated that patients with stent removal at 3 days had better urinary symptoms, pain scores, and general health compared to those with 7-day stent duration 5
• Another study found no difference in unplanned visits or complications between patients with stent removal within 3 days versus longer durations following routine ureteroscopy 2

Management of Retained Stents

If a stent is left in place beyond the recommended time:

• Careful planning is required for removal, especially if encrustation has occurred 6
• Multiple endourologic procedures (average 2.7) may be needed to remove the stent and associated stone burden 6
• Combination approaches may be necessary, including cystolitholapaxy, percutaneous nephrolithotomy, ureteroscopy, or extracorporeal shockwave lithotripsy 6

Key Pitfalls to Avoid

1. Forgetting to remove stents: Implement a tracking system to ensure timely removal
2. Leaving stents too long: Risk of encrustation, fragmentation, and infection increases significantly after 3 months
3. Removing stents too early: May lead to inadequate healing in cases of ureteral repair
4. Inadequate follow-up: Close monitoring is essential for early detection of complications
5. Using force during removal: Can result in severe ureteral injury or stent breakage 6

Remember that patient-specific factors may influence stent duration decisions, but the general principle remains: remove stents as soon as clinically appropriate to minimize complications.