Do ureter (urinary tube) stents need to be removed?

Ureteral Stent Removal: Clinical Guidelines and Management

Yes, ureteral stents absolutely need to be removed to prevent serious complications including encrustation, fragmentation, infection, and potential renal failure. 1, 2

Indications for Stent Placement and Removal

• Stents are placed for various indications including after ureteroscopy (URS), ureteral trauma, or to relieve obstruction 3
• Clear indications for post-URS stenting include ureteral injury, stricture, solitary kidney, renal insufficiency, and large residual stone burden 4, 3
• Routine stenting following uncomplicated URS is optional and not mandatory 4
• Routine stenting is not recommended as part of shock wave lithotripsy (SWL) 4

Complications of Retained Stents

• Forgotten or retained stents can lead to severe complications:
  • Stent fragmentation (10% of cases) 1
  • Stent migration (8.2% of cases) 1
  • Encrustation and stone formation 2
  • Hydronephrosis development or worsening (5.4% of cases) 1
  • Advanced renal failure in severe cases 2
  • Potentially lethal outcomes in complicated cases 2

Timing of Stent Removal

• Early stent removal (3 days post-procedure) is associated with:

  • Fewer urinary symptoms and less pain compared to longer durations 5
  • Improved general health scores 5
  • No significant increase in complications compared to longer durations 5

• Standard removal timing (7 days post-procedure):

  • Associated with more urinary symptoms and pain 5
  • Still considered safe and effective 6

• Early removal (10 days) after kidney transplantation shows no increase in surgical complications compared to later removal (20-30 days) 6

Patient Experience with Stents

• Ureteral stenting is associated with bothersome lower urinary tract symptoms and pain that can temporarily alter quality of life 4
• Patients with stents report:
  • Irritative urinary symptoms 7
  • Increased pain requiring more narcotic use 7
  • Missed work days 7
  • Symptoms improve significantly after stent removal 5

Management of Forgotten Stents

• Close follow-up of stented patients is essential for early detection of complications 1
• Complicated forgotten stents require specialized management:
  • Lithotripsy for encrusted stents 2
  • Percutaneous nephrostomy for severely encrusted or broken stents 2
  • Mechanical or laser lithotripsy for stents with stone formation 2

Clinical Pitfalls to Avoid

• Failing to document stent placement and establish a reliable system for tracking stent removal 2
• Underestimating the risk of forgotten stents, which can lead to severe complications including death 2
• Overlooking patient discomfort with stents, which can significantly impact quality of life 4, 7
• Routine stenting in uncomplicated cases where it may not be necessary 7

Conclusion for Clinical Practice

• All ureteral stents must be removed within their recommended timeframe to prevent serious complications 1, 2
• Consider early stent removal (3 days) when possible to improve patient comfort and quality of life 5
• For uncomplicated ureteroscopic procedures, consider omitting stent placement altogether 7
• Implement a reliable stent tracking system to prevent forgotten stents 2