Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure used to remove larger or complex kidney stones. During PCNL, a small tract is created through the skin to reach the kidney and remove or fragment the stone. A ureteral stent may be placed temporarily after the procedure to help urine drain from the kidney into the bladder while the urinary tract heals.

Patients commonly refer to this as a DJ stent, double-J stent or simply a kidney stent.

The stent is usually temporary. The exact timing of PCNL stent removal depends on why it was inserted, the amount of stone treated, urine drainage, healing, infection status and the surgeon's assessment.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides kidney-focused evaluation and postoperative kidney care for patients undergoing treatment for kidney stones and related kidney conditions.

Why Is a Stent Placed After PCNL?

A ureteral stent may be used to maintain urine flow from the kidney to the bladder after stone treatment.

Depending on the procedure and patient's condition, a stent can help:

• Maintain drainage from the kidney

• Allow the urinary tract to recover

• Facilitate passage of small residual fragments

• Reduce the risk of temporary blockage

• Support urine flow when the ureter is swollen or irritated

Not every patient requires the same type of drainage after PCNL. Some patients may also have a nephrostomy tube, which drains urine directly from the kidney through the skin. These are different devices and should not be confused with a DJ stent.

When Is the Stent Removed After PCNL?

There is no single removal day that applies to every patient.

Some short-term ureteral stents are removed within days, while others may remain for several weeks depending on the clinical situation. Cleveland Clinic notes that a ureteral stent may be removed after a short period when it is no longer needed, while longer-term stents require planned removal or replacement.

After PCNL, the treating urologist may decide the removal date based on:

• Whether the stone has been adequately cleared

• Presence of residual fragments

• Urine drainage

• Ureteral swelling

• Infection

• Kidney function

• Results of follow-up imaging

• Whether another procedure is planned

Therefore, patients should follow the specific removal schedule given by their treating team rather than relying on a fixed number of days found online.

How Is PCNL Stent Removal Done?

The method depends on the type of stent.

Stent With a Removal String

Some temporary stents have a string that extends outside the body.

When appropriate, a healthcare professional may remove the stent by gently pulling the string according to the planned instructions.

Patients should not pull or manipulate a stent themselves unless their treating doctor has specifically instructed them to do so.

Stent Without a String

Many ureteral stents do not have an external string.

These are commonly removed using a cystoscope. The clinician passes a small instrument through the urethra into the bladder, identifies the stent and removes it with specialized equipment.

The exact technique depends on the patient's anatomy, stent type and clinical circumstances.

Is PCNL Stent Removal Painful?

Stent removal is generally brief, but the experience varies between patients.

When a stent without a string is removed through cystoscopy, local anesthetic may be used to reduce discomfort. Some patients experience temporary burning, urinary urgency, bladder discomfort or mild pain afterward.

The level of discomfort can depend on:

• Individual sensitivity

• Type of stent

• Duration of placement

• Presence of urinary infection

• Irritation of the urinary tract

• Whether additional procedures are performed

Your treating doctor can explain what to expect based on the particular stent used during your PCNL.

What Symptoms Can Occur While the Stent Is Still in Place?

A ureteral stent can cause temporary urinary symptoms.

Possible symptoms include:

• Frequent urination

• Urgency to urinate

• Burning while passing urine

• Blood in urine

• Bladder discomfort

• Flank discomfort

• Pain during or after urination

These symptoms do not necessarily mean that the stent has become infected or displaced.

However, severe or worsening symptoms should be assessed rather than automatically attributed to the stent.

What Can Happen After PCNL Stent Removal?

After the stent is removed, some patients may experience temporary urinary discomfort.

Possible short-term symptoms include:

• Mild burning while urinating

• Increased urinary frequency

• Mild blood in urine

• Bladder discomfort

• Temporary flank discomfort

These symptoms often improve as the urinary tract settles.

The treating team may provide specific instructions regarding medicines, activity, hydration and follow-up.

How Long Does It Take to Recover After Stent Removal?

Recovery after stent removal varies.

Some people return to their normal routine quickly, while others may need additional time if they recently underwent extensive PCNL or have residual stone fragments.

Recovery is influenced by:

• Size and number of stones treated

• Complexity of the PCNL

• Presence of residual stones

• Infection

• Kidney function

• Other medical conditions

• Whether another procedure is required

PCNL itself can require a longer recovery period than the brief stent-removal procedure. Cleveland Clinic reports that overall recovery after PCNL commonly takes several weeks, although individual recovery varies.

What About the Nephrostomy Tube After PCNL?

A nephrostomy tube is different from a ureteral stent.

The nephrostomy tube drains urine directly from the kidney through an opening in the skin. It may be left in place after PCNL in selected patients.

If postoperative imaging and urine drainage are satisfactory, the nephrostomy tube may be removed according to the surgeon's plan.

Therefore, when a patient says “PCNL tube removal,” it is important to clarify whether they mean:

• DJ/ureteral stent removal, or

• Nephrostomy tube removal.

Why Might the Stent Need to Stay Longer?

A doctor may postpone stent removal when additional support for urinary drainage is needed.

Possible reasons include:

• Residual stone fragments

• Persistent swelling of the ureter

• Ongoing obstruction

• Infection requiring further management

• Additional stone treatment planned

• Concerns about urine drainage

• Complicated PCNL

• Other findings on follow-up imaging

The stent should remain only for the period considered appropriate by the treating specialist.

Should You Wait for the Stent to Fall Out Naturally?

Do not assume that a ureteral stent will always fall out on its own.

Some stents are designed for planned removal, while certain short-term stents have an external string. Stents without strings generally require removal by a healthcare professional.

A stent should also never be forgotten or left in place longer than instructed, because prolonged stent placement can increase the risk of complications.

If you are uncertain about your planned removal date, contact the treating hospital or urologist.

What Happens If a PCNL Stent Is Not Removed on Time?

A stent that remains in place longer than intended can develop complications.

Potential problems include:

• Mineral deposits or encrustation

• Infection

• Blockage

• Stent migration

• Urinary symptoms

• Difficulty removing the stent after prolonged placement

The appropriate duration depends on the type of stent and the patient's circumstances.

For this reason, patients should keep their scheduled follow-up appointment and confirm the planned removal date before leaving the hospital.

Can Kidney Stones Remain After PCNL?

PCNL is highly effective for many large kidney stones, but complete stone clearance cannot be guaranteed in every patient.

Residual fragments may remain because of:

• Multiple stones

• Difficult kidney anatomy

• Stones located in separate calyces

• Complex stone burden

• Limited access during the procedure

Additional imaging may be used to determine whether significant residual stones remain and whether further treatment is necessary. PCNL may sometimes require additional procedures depending on stone burden and clinical circumstances.

What Tests May Be Done Before Stent Removal?

The need for testing varies from patient to patient.

The treating team may review:

• Symptoms

• Urine output

• Urinalysis

• Urine culture when infection is suspected

• Serum creatinine

• eGFR

• Other blood tests

• Ultrasound

• X-ray

• CT imaging when clinically necessary

Imaging can be particularly useful when the doctor needs to determine whether stones remain or whether urinary drainage has improved.

The objective is to make sure that removing the stent is appropriate and safe.

Can the Stent Be Removed If There Is an Infection?

An active urinary infection requires appropriate medical assessment before deciding what to do with a stent.

A patient with fever, chills, worsening flank pain or other signs of infection should contact their healthcare team promptly.

Treatment may require urine testing and antibiotics when a bacterial infection is identified. In complicated situations, the timing of stent removal or further urinary drainage must be determined by the treating specialist.

Fever with severe flank pain, reduced urine output or rapidly worsening illness requires urgent medical attention.

What Should You Do After PCNL Stent Removal?

Follow the discharge instructions provided by the treating team.

Depending on your situation, you may be advised to:

• Take prescribed medicines as directed

• Maintain the recommended fluid intake

• Avoid strenuous activity for the period advised

• Watch for fever or worsening pain

• Monitor urine changes

• Attend scheduled imaging or follow-up

• Complete stone analysis or metabolic evaluation when recommended

Do not dramatically increase fluid intake unless your doctor has advised it, particularly if you have kidney disease, heart disease or a fluid restriction.

Can PCNL Stent Removal Affect Kidney Function?

Removing a properly placed temporary stent does not normally mean that kidney function will deteriorate.

The purpose of the stent is to support urinary drainage while the urinary tract heals.

However, kidney function can be affected if there is persistent obstruction, infection, residual stone burden or another underlying problem.

Patients with pre-existing kidney disease may therefore require closer monitoring of creatinine and eGFR.

When Should You Contact a Doctor After Stent Removal?

Contact your healthcare provider if you develop:

• Persistent or worsening flank pain

• Fever or chills

• Increasing blood in urine

• Difficulty passing urine

• Very little urine

• Severe burning during urination

• Repeated vomiting

• Severe weakness

• Worsening urinary symptoms

Seek urgent medical care if symptoms suggest significant infection, urinary obstruction or rapid deterioration.

PCNL Follow-Up at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides kidney-focused evaluation for patients recovering from kidney stone procedures and those with associated kidney-function concerns.

Depending on the clinical situation, follow-up may include:

• Review of PCNL records

• Assessment of creatinine and eGFR

• Urine testing

• Evaluation of urinary symptoms

• Review of ultrasound, X-ray or CT reports

• Assessment of residual stone burden

• Evaluation of urinary obstruction

• Monitoring for infection

• Kidney-function monitoring after stone treatment

• Coordination with an appropriate urologist for stent or stone-related procedures

Because PCNL and stent removal are procedural matters, the exact removal plan should be determined by the treating urology team according to the patient's procedure and recovery.

Frequently Asked Questions

How many days after PCNL is the stent removed?

There is no universal number of days. The timing depends on the reason the stent was inserted, stone clearance, urinary drainage, infection status and the treating specialist's assessment.

Is stent removal after PCNL painful?

It can cause temporary discomfort, burning or urinary urgency, but the experience varies. Stents without strings are commonly removed using cystoscopy, often with local anesthetic.

Can a DJ stent be removed without surgery?

Some short-term stents with a removal string can be removed without a cystoscopic procedure when specifically instructed by the treating clinician. Stents without strings generally require removal by a healthcare professional.

What happens if the PCNL stent is left too long?

Prolonged stent placement can increase the risk of encrustation, infection, blockage and other complications. The stent should be removed or exchanged according to the prescribed schedule.

Is blood in urine normal after PCNL stent removal?

A small amount of blood may occur temporarily after urinary tract procedures, but heavy or persistent bleeding, blood clots, severe pain or reduced urine output requires medical assessment.

Can I drink water after PCNL stent removal?

Fluid intake should follow your doctor's instructions. Adequate hydration may be recommended for some patients, but people with kidney failure, heart disease or prescribed fluid restrictions should not increase their intake without medical advice.

Does everyone need a stent after PCNL?

No. The use of a ureteral stent or nephrostomy tube depends on the procedure, stone characteristics, urinary drainage and the patient's clinical situation.

Who removes a PCNL stent?

A ureteral stent is generally removed according to the plan of the treating urologist or healthcare team. A nephrologist may be involved when kidney function or medical kidney disease requires assessment.

Conclusion

PCNL stent removal is an important part of follow-up for many patients who have undergone percutaneous kidney stone surgery. A temporary ureteral or DJ stent may be used to support urine drainage while the urinary tract recovers, but the timing of removal differs from one patient to another.

Before removing the stent, the treating team may consider stone clearance, urine drainage, infection, residual fragments, kidney function and follow-up imaging. Stent removal is generally a short procedure, although temporary urinary discomfort can occur afterward.

Patients should not remove, pull or ignore a stent without following the instructions provided by their healthcare team. Fever, severe flank pain, inability to pass urine, heavy bleeding or rapidly worsening symptoms require prompt medical assessment.

For kidney-function evaluation and follow-up after kidney stone procedures, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not be considered a substitute for medical diagnosis, treatment or individualized medical advice. The timing and method of PCNL stent removal depend on the type of stent, stone clearance, urinary drainage, infection status, kidney function and the treating specialist's assessment. Do not pull, cut or remove a ureteral stent or nephrostomy tube unless specifically instructed by your healthcare professional. Do not start antibiotics, pain medicines or other treatments without appropriate medical advice. Seek urgent medical attention for fever or chills with flank pain, very little or no urine, severe or worsening pain, heavy bleeding, persistent vomiting, confusion or rapidly worsening health. Consult Dr. Sandip Prabhakar Bhurke or an appropriate qualified urology/nephrology specialist for individualized care.