Objectives: To evaluate the impact of ureteric stent removal by string vs ureteric stent removal by cystoscope with regard to pain at ureteric stent removal, complications and quality of life, as well as patients’ self-rated symptoms, after ureteroscopy (URS) for urolithiasis.

Patients and methods: Of 328 patients who underwent URS for upper urinary tract stones at our institution, 149 were randomly divided into a ureteric stent removal by string group (string group) and a ureteric stent removal by flexible cystoscope group (cystoscope group), using gender as a stratification factor. We focused on four sites, namely, the upper abdomen, bladder, flank and urethra, to evaluate the most painful site at stent removal. The primary endpoint was total pain scores for four sites at stent removal in the string group vs the cystoscope group. Secondary endpoints included comparison of the psychological well-being scores of patients using the five-item World Health Organization well-being index (WHO-5) preoperatively, pre-stent removal and 2 weeks after stent removal between the string group and cystoscope group.

Results: Of 149 patients analysed, 74 were in the string group and 75 were in the cystoscope group. In most patients, the ureteric stent was removed ~10 days after URS. The string group experienced significantly less pain than the cystoscope group (mean visual analogue scale [VAS] scores 2.73 vs 5.67; P < 0.001). Although VAS scores for women were not significantly different between the groups (P = 0.300), those for men were significantly lower in the string group (P < 0.001). In particular, men in the string group experienced significantly less urethral pain than those in the cystoscope group. The WHO-5 scores were not significantly different between the groups preoperatively, pre-stent removal or 2 weeks after stent removal. Stent string-related complications and self-rated symptoms were also not significantly different.

Conclusion: Ureteric stent removal by string after URS led to significantly less pain than removal by cystoscope in men. Patients in the string group experienced no more complications in terms of urinary tract infections or accidental dislodgement than those in the cytoscope group.