Men – When the ureteral stent is inserted, the attached string should be left connected to the stent and a loop should be created in the string at the point where the string exits the urethra (see figure 1).
This loop will self-retract into the urethra, with a slight tug on the genitalia, where it comes to rest in the bulbous urethra or anterior urethra and it is not symptomatic. At time of removal, after the instillation of an urethral anesthetic lubricant, the snare is passed into a man’s urethra until the bulbous portion (see figure 2). Rotating the snare, the loop at the end of the string is hooked by the snare and then gently pulled out (see figure 3). Occasionally more than one pass is required. If multiple passes do not allow the snare to hook the string loop, it is possible that that the loop could have retracted into the bladder and cystoscopic removal is required. In men the snare should not be passed beyond the bulbous urethra.
Women – In women, the loop does not self-retract, but has to be pushed into the bladder with the scope or a well-lubricated hemostat. The hook of the snare enters the bladder and may grab the string or the stent itself (see figure 4). If the snare misses, repeat passes, or US supervision can be used to locate the stent. Cystoscopic removal is the fallback option.