Men (18F Snare should be used) – When the ureteral stent is inserted, the attached string should be left connected to the stent and a 2 cm diameter loop should be created in the string at the point where the string exits the urethra (see figure 1). The loop can be locked in place by placing several knots.

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 5-10 cc of an an anesthetic lubricant, the snare is passed into a man’s urethra until the bulbous portion (see figure 2). Rotating the snare as it is slowly withdrawn will hook the loop at the end of the string and pull it out (see figure 3). Occasionally more than one pass is required. If multiple passes, usually 3, do not successfully engage 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 (16F Snare recommended, but 18F can also be used. If unsure of the angle of the course of the urethra, passage over a guide wire is recommended) – In women the loop is not in a confined space and engaging it may require more manipulation. It is suggested that more than one loop be made in the string to increase the chance of hooking one of the loops. The loop does not self-retract, but has to be pushed into the bladder with the scope or a well-lubricated hemostat.

The snare enters the bladder and is directed towards the side of the stent. A finger in the vagina can help with localization of the snare and the stent itself. The snare may grab the stent itself or one of the string loops. If the stent itself is engaged, a proprioceptive feedback tug will be felt. If the snare misses, repeat passes can be made. Cystoscopic removal is the fallback option.