Is ureteral stent removal painful?

Is Ureteral Stent Removal Painful?

Yes, ureteral stent removal is painful or uncomfortable for the majority of patients, with approximately 80-95% experiencing some degree of discomfort during the procedure and 55-64% reporting symptoms afterward, though the pain is typically brief and self-limiting. 1, 2, 3, 4

Pain During the Removal Procedure

• Almost all patients (approximately 82%) experience either pain or discomfort during the actual stent removal, but for most (approximately 66%), the pain is of short duration, lasting only seconds to minutes 2
• The procedure itself involves cystoscopic visualization and grasping of the stent, which causes transient urethral and bladder discomfort 5
• A single dose of an NSAID (such as rofecoxib 50 mg or equivalent) given before stent removal prevents severe pain in the 24 hours following removal, reducing the incidence from 55% to 0% in one randomized controlled trial 3

Post-Removal Symptoms

• Approximately 64% of patients experience symptoms after stent removal, including pain, hematuria, urinary frequency, urgency, or fever 1
• Among those with post-removal symptoms, 60% specifically experience pain or discomfort 1
• Most post-removal symptoms resolve within 24 hours, though a minority of patients describe symptoms persisting for more than one day 2

Predictors of More Severe Pain

• Patients who experienced discomfort while the stent was indwelling are significantly more likely to have pain after stent removal 1
• Stone basketing procedures during the initial ureteroscopy correlate positively with increased post-removal pain 1
• Conversely, anticholinergic use during the stent indwelling period and longer stent duration are associated with less pain after removal 1

Psychological Distress Component

• Many patients (approximately 55%) describe significant anticipatory anxiety related to the removal procedure 2
• Several patients (approximately 29%) report discomfort arising from lack of privacy or feeling exposed during the procedure 2
• Provider interactions can either help put patients at ease or increase discomfort, highlighting the importance of clear communication 2

Pain Management Strategies

Pre-Removal Prophylaxis

• Administer a single dose of an NSAID (such as ketorolac 30 mg IV/IM or ibuprofen 600-800 mg PO) 30-60 minutes before the procedure to prevent severe post-removal pain 3

Procedural Anesthesia Options

• Intravenous analgesics alone result in significantly higher pain scores and lower satisfaction compared to sedation approaches 5
• Moderate sedation with midazolam provides significantly less pain and higher satisfaction than analgesics alone 5
• General anesthesia using propofol without muscle relaxation provides the least pain and highest satisfaction rates, with no patients requesting alternative treatment modalities in future procedures 5

Post-Removal Management

• A multimodal approach combining alpha-blockers, anticholinergic medications, anti-inflammatory drugs, and narcotic pain medications as needed is most effective for managing post-removal symptoms 4
• Patients should be counseled that lingering urinary symptoms (frequency, urgency, mild dysuria) may persist for 24-48 hours but typically resolve spontaneously 2

Critical Communication Points

• Inform patients preoperatively that they will likely experience brief discomfort during removal but that it is typically short-lived 2
• Explain the possibility of delayed pain or urinary symptoms in the 24 hours following removal to help patients adapt to discomfort 2
• Set expectations that approximately two-thirds of patients experience some symptoms after removal, but these are usually self-limiting 1
• Reassure patients that severe, prolonged pain is uncommon and should prompt contact with their urologist 2

Common Pitfalls to Avoid

• Failing to provide prophylactic NSAIDs before removal, which can prevent severe pain in the majority of patients 3
• Underestimating the psychological distress component and not addressing anticipatory anxiety through clear communication 2
• Not offering sedation options for anxious patients or those with prior negative experiences with cystoscopy 5
• Dismissing patient concerns about post-removal symptoms without providing specific guidance on expected duration and management 2