Ureteral Stent: Procedure, Recovery & What to Expect

What Is a Ureteral Stent?

A ureteral stent (also called a JJ stent or double-J stent) is a thin, flexible plastic tube that is placed inside your ureter to keep it open and allow urine to flow from your kidney to your bladder. The stent has coiled ends that hold it in place - one coil sits in your kidney and the other in your bladder.

The ureter is the tube that carries urine from each kidney down to the bladder. Normally, urine flows freely through this tube. However, when something blocks the ureter - such as a kidney stone, tumor, or scar tissue - urine cannot drain properly. This can cause pain, kidney damage, and infection.

A ureteral stent acts as a temporary scaffold that holds the ureter open, creating a channel for urine to bypass the obstruction. The stent is entirely internal - it cannot be seen from outside your body, and you cannot feel it with your hands. However, you may notice some symptoms related to having a foreign object in your urinary tract.

Ureteral stents are made of soft, biocompatible plastic materials such as polyurethane or silicone. They come in various lengths and diameters to fit different patients. The distinctive "J" shape at each end prevents the stent from migrating up into the kidney or down into the bladder. This is why they are commonly called "JJ stents" or "double-J stents."

Types of Ureteral Stents

There are several types of ureteral stents available, each designed for specific clinical situations:

• Standard polyurethane stents: The most common type, suitable for most temporary placements lasting 4-6 weeks
• Silicone stents: Softer and more flexible, often better tolerated with fewer symptoms
• Metal stents: Used for long-term placement in patients with malignant obstruction
• Drug-eluting stents: Coated with medication to reduce infection or encrustation
• Stents with extraction strings: Have an attached string for easier removal without cystoscopy

Your urologist will choose the appropriate type based on why you need the stent, how long it will need to stay in place, and your individual anatomy.

Why Do You Need a Ureteral Stent?

You may need a ureteral stent if something is blocking the flow of urine from your kidney to your bladder. Common reasons include kidney stones, tumors compressing the ureter, scar tissue from previous surgery, or after certain urological procedures to promote healing.

The urinary system relies on the smooth flow of urine from the kidneys through the ureters and into the bladder. When this flow is interrupted, several serious problems can develop. The kidney may swell with backed-up urine (a condition called hydronephrosis), causing pain and potentially permanent damage to kidney tissue. Bacteria can multiply in stagnant urine, leading to serious infections. Without treatment, a complete blockage can lead to kidney failure.

Ureteral stents provide an immediate solution by creating an alternate pathway for urine to drain, even if the original obstruction remains. This relieves symptoms, protects kidney function, and allows time for definitive treatment of the underlying cause.

Common Reasons for Ureteral Stent Placement

Urologists place ureteral stents for many different conditions:

Kidney stones are one of the most common reasons for stent placement. When a stone is too large to pass on its own or is causing significant obstruction, a stent can be placed before or after stone removal procedures. The stent helps reduce swelling in the ureter and ensures urine can drain while the ureter heals. After procedures like ureteroscopy or shock wave lithotripsy (ESWL), stents prevent blockage from stone fragments or post-operative swelling.

Ureteral strictures (narrowing from scar tissue) can develop after previous surgery, radiation therapy, or injury. Stents keep the narrowed area open and may be part of a treatment plan to dilate the stricture over time. In some cases, patients need long-term stenting if the stricture cannot be permanently repaired.

Cancer-related obstruction occurs when tumors of the bladder, prostate, cervix, colon, or other pelvic organs compress or invade the ureter. Stents can restore kidney function and relieve pain in these patients, sometimes as a palliative measure to improve quality of life.

Post-surgical placement is common after ureteral repair, kidney transplant, or reconstructive surgery. The stent supports the healing ureter and ensures a patent channel for urine flow during recovery.

How Should You Prepare for the Procedure?

Preparation for ureteral stent placement includes avoiding smoking and alcohol for several weeks before surgery, fasting for 4 hours, taking an antiseptic shower the night before and morning of the procedure, and informing your doctor about all medications you take.

Proper preparation helps ensure a smooth procedure and reduces the risk of complications. Your healthcare team will provide specific instructions based on your individual situation, but there are several general guidelines that apply to most patients undergoing ureteral stent placement.

Lifestyle Modifications Before Surgery

Smoking and alcohol consumption can significantly impact your healing and increase the risk of complications. Smoking impairs blood flow and delays wound healing, while alcohol can interact with anesthesia and medications. Most surgeons recommend:

• Stop smoking at least 2-4 weeks before the procedure if possible
• Avoid alcohol for at least 1 week before surgery
• Continue these restrictions for several weeks after the procedure for optimal healing

Medication Review

Tell your doctor about all medications you take, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements. Some medications may need to be adjusted or temporarily stopped:

• Blood thinners (warfarin, aspirin, clopidogrel) may need to be stopped several days before the procedure to reduce bleeding risk
• Diabetes medications may need dose adjustments due to fasting requirements
• Blood pressure medications are usually continued but taken with a small sip of water

Never stop any medication without discussing it with your doctor first. Your healthcare team will provide specific guidance about which medications to continue, which to stop, and when.

Day Before and Day of Procedure

The evening before your procedure, you should shower using the antiseptic soap provided by your healthcare team. Repeat this shower on the morning of your procedure. These antiseptic washes help reduce bacteria on your skin and lower the risk of infection.

After your antiseptic shower, put on clean clothes and sleep in clean sheets. On the morning of the procedure, use fresh towels and wear clean clothes to the hospital.

You will typically need to fast (no food or drink) for 4-6 hours before the procedure if you are receiving sedation or general anesthesia. Clear liquids may be allowed up to 2 hours before in some cases. Follow your specific instructions carefully.

How Is the Procedure Performed?

Ureteral stent placement is performed using a cystoscope (a thin camera inserted through the urethra) to guide the stent into position. The procedure typically takes 15-30 minutes and can be done under local anesthesia, sedation, or general anesthesia. Most patients go home the same day.

Ureteral stent placement is a minimally invasive procedure performed by a urologist. The technique uses the body's natural urinary pathway - no incisions are needed. Understanding what happens during the procedure can help reduce anxiety and prepare you for what to expect.

Types of Anesthesia

The procedure can be performed under different types of anesthesia depending on your medical condition, the complexity of the procedure, and your preferences:

Local anesthesia involves applying numbing gel to the urethra. You remain awake but feel minimal discomfort. This is often used for simple, straightforward stent placements.

Sedation (twilight anesthesia) combines local anesthesia with intravenous medications that make you drowsy and relaxed. You may not remember the procedure afterward but are not fully unconscious.

General anesthesia puts you completely to sleep. This is typically used for more complex cases, anxious patients, or when the stent placement is combined with other procedures like stone removal.

Step-by-Step Procedure

Once anesthesia is administered, the procedure follows these steps:

1. Cystoscope insertion: The urologist gently inserts a cystoscope (a thin, flexible or rigid tube with a camera and light) through your urethra and into your bladder. This allows visualization of the bladder and the openings of the ureters.

2. Guidewire placement: A thin, flexible guidewire is carefully advanced through the ureteral opening and up into the kidney. This may be done under fluoroscopic (X-ray) guidance to ensure proper positioning.

3. Stent insertion: The stent is threaded over the guidewire and pushed into position. The coiled end in the kidney prevents upward migration, while the coiled end in the bladder prevents it from slipping out.

4. Position confirmation: The urologist uses fluoroscopy or direct visualization to confirm that both ends of the stent are properly coiled and the stent is not kinked or malpositioned.

5. Guidewire removal: Once the stent is correctly positioned, the guidewire and cystoscope are removed.

The entire procedure typically takes 15-30 minutes, though it may take longer if there are anatomical challenges or if other procedures are performed at the same time.

What Happens After the Procedure?

Most people feel well after the procedure and can go home the same day. Common symptoms include urinary urgency, frequency, and mild discomfort when urinating - these typically improve within a few days as your body adjusts to the stent. You can usually return to normal activities within 1-3 days.

Recovery from ureteral stent placement is generally quick, but it's important to know what to expect in the days and weeks following the procedure. While the stent is doing its job of keeping your ureter open, you may experience some symptoms related to having a foreign object in your urinary tract.

Immediately After the Procedure

In the recovery room, nurses will monitor your vital signs and ensure you can urinate before discharge. You may feel some burning or urgency with your first urinations - this is normal. Light pink urine is also common and not a cause for concern.

If you received sedation or general anesthesia, you will need someone to drive you home. Plan to rest for the remainder of the day. Most patients feel well enough to resume light activities the next day.

Common Symptoms with a Ureteral Stent

Approximately 80% of patients experience some stent-related symptoms. These are normal and usually improve with time as your body adapts to the stent:

• Urinary urgency and frequency: The coiled end of the stent in the bladder can irritate the bladder wall, making you feel like you need to urinate more often. This is the most common symptom.
• Burning during urination: Mild burning or stinging when you urinate is common, especially in the first few days.
• Flank pain: Some people experience discomfort in their back or side (flank), especially when urinating. This occurs because bladder contraction during urination can cause reflux of urine up the stent and into the kidney.
• Blood in urine (hematuria): Pink or slightly bloody urine is common, particularly after physical activity. Drinking plenty of fluids helps dilute the urine and reduces this symptom.
• Bladder spasms: The stent can trigger involuntary bladder contractions, causing sudden urgency or brief discomfort.

Managing Stent-Related Symptoms

There are several strategies to help manage stent-related discomfort:

Stay well hydrated: Drinking 2-3 liters of water daily helps flush the urinary system, dilutes urine (reducing irritation), and may reduce the risk of infection and encrustation.

Medications: Your doctor may prescribe medications to help with symptoms, including:

• Alpha-blockers (such as tamsulosin) can relax smooth muscle and reduce urinary symptoms
• Anticholinergic medications can reduce bladder spasms
• Over-the-counter pain relievers like ibuprofen or acetaminophen can help with mild discomfort

Avoid irritating substances: Caffeine, alcohol, and spicy foods can irritate the bladder and worsen symptoms. Consider limiting these while you have the stent.

Activity Levels

You can generally resume normal activities within a few days after stent placement. Light walking is encouraged from day one to promote circulation and recovery. Most people can return to work within 2-3 days for desk jobs, though physically demanding work may require more time.

Exercise is generally safe and encouraged, though strenuous activity may temporarily increase blood in the urine. Sexual intercourse is also safe once you feel comfortable, typically after a few days. Listen to your body and reduce activity if you experience significant discomfort.

When and How Is the Stent Removed?

Ureteral stent removal is a quick outpatient procedure taking 5-10 minutes. Local anesthetic gel is applied to the urethra, and the stent is removed using a cystoscope. Some stents have attached strings for removal without cystoscopy. Never leave a stent in longer than recommended.

The timing of stent removal depends on why it was placed and what type of stent was used. Your urologist will provide specific guidance about when your stent should be removed.

How Long Does a Stent Stay In?

Stent duration varies widely based on the clinical indication:

• After uncomplicated ureteroscopy: 1-2 weeks
• After stone removal procedures: 2-4 weeks
• For ureteral healing after injury or surgery: 4-6 weeks
• For stricture management: 6 weeks to several months
• For malignant obstruction: Indefinite, with exchanges every 3-6 months

The maximum time a stent can safely remain in place depends on the stent material. Standard polyurethane stents should generally be removed or exchanged within 3-4 months. Silicone and specialized long-term stents may safely remain for 6-12 months. Leaving a stent in too long can lead to encrustation (mineral buildup), blockage, infection, and difficulty with removal.

The Removal Procedure

Stent removal is usually a quick office procedure:

Standard removal with cystoscopy: Local anesthetic gel is applied to the urethra. A flexible cystoscope is inserted into the bladder, where the urologist visualizes the stent and grasps it with forceps to gently remove it. The procedure takes about 5-10 minutes and most patients tolerate it well with minimal discomfort.

String removal: Some stents are placed with an attached extraction string that exits through the urethra. For these stents, removal is even simpler - the string is gently pulled to extract the stent without any instruments. This can often be done by the patient themselves or by a nurse.

After removal, you may experience mild burning with urination and slightly bloody urine for a day or two. These symptoms typically resolve quickly. Drinking plenty of water helps flush the system and reduces discomfort.

What Are the Possible Complications?

Serious complications from ureteral stents are uncommon. The most common issues are stent-related symptoms (urgency, frequency, discomfort) and urinary tract infections. Rare but serious complications include stent migration, encrustation, and kidney damage - these risks increase if the stent is left in too long.

While ureteral stents are generally safe and well-tolerated, it's important to be aware of potential complications so you can seek prompt medical attention if needed. Understanding the difference between normal stent symptoms and warning signs of complications helps ensure optimal outcomes.

Common Issues (Expected Stent Symptoms)

As discussed earlier, approximately 80% of patients experience some combination of urinary urgency, frequency, discomfort with urination, flank pain, and blood in urine. While bothersome, these are normal responses to having a stent and not true complications. They typically improve with time and medication management.

Urinary Tract Infection

Urinary tract infections (UTIs) occur in about 10-25% of patients with stents. The stent provides a surface where bacteria can attach and form biofilms, making infection more likely. Symptoms of UTI include fever, chills, cloudy or foul-smelling urine, increased pain, and feeling generally unwell.

If you suspect a UTI, contact your healthcare provider promptly. UTIs in patients with stents require antibiotic treatment and sometimes early stent removal.

Stent Migration

Occasionally, a stent can move out of its intended position - either upward into the kidney or downward into the bladder or even out through the urethra. Migration may cause increased pain, decreased urine output, or visible protrusion of the stent. If you notice your stent has moved, contact your urologist.

Encrustation and Blockage

Over time, minerals in the urine can deposit on the stent surface, forming a crusty coating called encrustation. This risk increases significantly if the stent is left in longer than recommended, if you have metabolic abnormalities, or if you're dehydrated. Severe encrustation can block the stent, making it ineffective, and can make removal very difficult.

When to Seek Medical Care

Contact your healthcare provider or seek emergency care if you experience:

• Fever above 38.5°C (101.3°F) or chills - may indicate infection
• Severe pain not relieved by prescribed medications
• Inability to urinate - may indicate stent blockage
• Heavy bleeding with large clots or bright red blood
• Visible stent protruding from the urethra
• Symptoms of UTI - burning, frequency, cloudy urine with fever

Most complications can be successfully managed when identified early. Don't hesitate to contact your healthcare team with any concerns.

How Can You Live Comfortably with a Stent?

Living with a ureteral stent is manageable for most people. Stay well hydrated, take prescribed medications, avoid bladder irritants like caffeine and alcohol, and listen to your body regarding activity levels. Most people can work, exercise, and maintain their normal routine with a stent in place.

Having a ureteral stent is temporary, and understanding how to manage symptoms can make the experience much more comfortable. While some adjustment is needed, most people are able to continue their normal lives with relatively minor modifications.

Daily Living Tips

These practical strategies can help minimize stent-related discomfort:

Hydration is key: Aim for 2-3 liters of water daily unless your doctor advises otherwise. Well-diluted urine is less irritating and reduces the risk of infection and encrustation. Carry a water bottle with you and sip throughout the day.

Dietary modifications: While you don't need a special diet, avoiding bladder irritants can reduce symptoms. Consider limiting caffeine (coffee, tea, cola), alcohol, spicy foods, acidic foods (tomatoes, citrus), and artificial sweeteners.

Urinate when you need to: Don't hold your urine for long periods. Empty your bladder regularly to reduce pressure and discomfort.

Take medications as prescribed: If your doctor prescribed alpha-blockers or other medications, take them consistently for best symptom relief.

Dress comfortably: Avoid tight clothing that puts pressure on your bladder or abdomen.

Exercise and Physical Activity

Physical activity is generally encouraged and safe with a stent. However, some modifications may help:

• Start with light activities and gradually increase intensity
• Stay extra hydrated before, during, and after exercise
• Empty your bladder before exercise
• Expect some increase in blood in urine after vigorous activity - this is usually harmless
• Contact sports may increase discomfort but are not strictly prohibited

Work and Travel

Most people can work with a stent in place. For desk jobs, you may need more frequent bathroom breaks. For physically demanding work, discuss timing with your doctor - you may benefit from a few extra days off initially.

Traveling with a stent is possible, but plan ahead. Know where restrooms are located, carry pain medication, and stay hydrated (especially during flights). If traveling internationally, carry documentation of your stent in case you need medical care.

Sexual Activity

Sexual intercourse is generally safe with a ureteral stent once you feel comfortable, typically a few days after placement. The stent cannot be felt by a partner and cannot be displaced during sex. Some people experience increased urgency or mild discomfort afterward - this is normal. Urinating before and after intercourse can help reduce discomfort.