How long is a stent left in place after kidney stone removal?

Duration of Ureteral Stent Placement After Kidney Stone Removal

For uncomplicated ureteroscopic kidney stone removal, ureteral stents should be removed within 3-7 days to minimize patient morbidity while maintaining safety, with 5 days appearing to be the optimal minimum duration.

Evidence-Based Stent Duration Recommendations

Optimal Timing: 5-7 Days

• Stents should remain in place for at least 5 days after ureteroscopy to reduce the risk of postoperative emergency department visits, as dwell times of ≤4 days are associated with significantly increased emergency visits around the time of stent removal 1

• Removal at 3 days is associated with better patient-reported outcomes compared to 7 days, including improved urinary symptoms (p < 0.001), less pain (p < 0.001), and better general health scores (p = 0.02), with no significant difference in complication rates 2

• Stent duration under 14 days significantly reduces adverse events, as patients with stenting >15 days have a significantly higher ratio of complications such as fever or lumbago (p = 0.041) and require more antibiotic use 3

Stent-Related Morbidity by Duration

• During the first week with stent in place, patients experience significantly more irritative urinary symptoms (p < 0.0001), pain (p < 0.0001), miss more work days (p < 0.01), and use more narcotics (p < 0.0005) compared to unstented patients 4

• Stents with extraction strings allow for shorter dwell times (median 5 days vs 9 days without strings), though very short dwell times (<5 days) may increase emergency department visits 1

When Stenting May Be Omitted

Criteria for Stentless Approach

• For uncomplicated ureteroscopic treatment of proximal ureteral and renal stones ≤1.5 cm, omitting stents is safe and results in decreased urinary symptoms, less pain, and improved short-term quality of life with similar complication rates 4

• Stone-free rates remain excellent (94%) without routine stenting in appropriately selected patients undergoing uncomplicated procedures 4

Risk of Stentless Approach

• Approximately 8-9% of unstented patients may require subsequent stent placement for complications, though this is balanced against the morbidity of routine stenting 4

Long-Term Stenting Complications

Extended Duration Risks (>3 Months)

• Late complications occur in 32.7% of patients when stents are left in place for extended periods (3-12 months) 5

• Specific complications include: stent fragmentation (10%), stent migration (8.2%), persistent or worsening hydronephrosis despite stenting (5.4%), and symptomatic complications requiring early removal (9.1%) 5

Clinical Algorithm for Stent Duration

For routine ureteroscopic stone removal:

1. Uncomplicated cases with stones ≤1.5 cm: Consider omitting stent entirely 4
2. If stent placed with extraction string: Remove at 5-7 days 1, 2
3. If stent placed without string: Remove at 7-14 days maximum 3
4. Never exceed 14 days unless specific complications require longer duration 3

For complex cases or staghorn calculi:

• Stents may be left indwelling to maintain drainage while fragments pass after shock wave lithotripsy, though specific duration is not standardized 6

Key Pitfalls to Avoid

• Do not routinely leave stents beyond 14 days, as this significantly increases febrile complications and antibiotic requirements 3

• Avoid stent dwell times of ≤4 days when using extraction strings, as this increases emergency department visits despite the convenience of early removal 1

• Do not assume all patients require routine stenting after uncomplicated ureteroscopy for upper tract stones, as selective stenting reduces overall morbidity 4