Severe pain after stent removal: How often does it happen and can anything prevent it?

Can a single pill prevent post stent removal pain? (Image from Office.com)

Many patients complain of some pain after having a ureteral stent is removed. This pain is usually mild and self-limited. However, the pain can sometimes be severe. Because patients may not have been warned about the possibility of significant pain beforehand, it can come as an unwelcome surprise, and patients may be left wondering whether something is wrong. Patients who are affected by this pain may describe it as being worse than their original stone pain. In some cases the pain can be bad enough to bring them back to the emergency room.

Up to now, there hasn’t been much research on this topic and it was not clear how often this phenomenon occurs or what might be done to prevent it. A recent publication in the journal BJU International now suggests that severe pain after stent removal may occur in as many as half (55%) of patients. In the study, performed by researchers at Oregon Health & Science University and the Portland Veterans Administration Medical Center, patients having their indwelling ureteral stents removed were either given a placebo pill or a single 50mg dose of the non-steroidal anti-inflammatory drug (NSAID) rofecoxib fifteen minutes before their stent removal procedure. Patients were asked to report their pain just before and 24 hours after their stent removal on a scale ranging from 1 to 10, with 7 or above being considered severe pain. Six of the eleven patients (55%) given placebo developed severe pain after their stent removal while none of the ten patients given rofecoxib developed severe pain.

The authors speculated that the mechanism by which the NSAID medicine may have provided such a dramatic reduction in severe pain occurrence might have been through reducing ureteral spasms or by decreasing pressure within the kidney. While the results of the study are very encouraging, further research will be needed to confirm the findings. For now though, the study is currently the only evidence we have on how often post stent removal severe pain occurs and what we might do to prevent it – take a single dose of a NSAID pain medication fifteen minutes before removing a stent.

Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available. The authors report in their paper that they now use a single 220mg dose of the NSAID naproxen with their patients. Naproxen is available over the counter (as a generic or under brand names such as Aleve) but you should check with your doctor about whether you should take it and make sure to read the warnings from the manufacturer as some patients with certain medical conditions shouldn’t take it.

While you might think that a single pill of naproxen can’t be very strong, other research actually supports its use for acute pain. In 15 randomized studies involving 1509 participants, naproxen was found to be effective for relieving moderate to severe pain in patients after surgery. Half of patients who were given a single dose of naproxen experienced at least half pain relief and the effects of the medicine lasted on average for up to nine hours. You can read more about naproxen for postoperative pain at the Cochrane Collaboration website.

REFERENCE: Tadros NN, Bland L, Legg E, Olyaei A, Conlin MJ. “A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial. BJU International, 2012.

About Dr. Mike Nguyen

Mike M Nguyen, MD, MPH, is a urologist and an Associate Professor of Clinical Urology at the Keck School of Medicine of USC in Los Angeles, CA. He specializes in the treatment of kidney stones with both surgery and dietary prevention and the in the treatment of kidney and prostate cancer using the latest robotic and laparoscopic surgical approaches. He sees patients patients at USC-Keck urology clinics located in Los Angeles, Pasadena, and La Canada, CA. He is the founder of the www.KidneyStoners.org website.
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39 Responses to Severe pain after stent removal: How often does it happen and can anything prevent it?

  1. Shaun says:

    I just had a stent put in about 4 weeks ago and was miserable the entire week it was in. Unfortunately, I didn’t know about this website then and wasn’t informed by my doctor that it could be uncomfortable (putting that mildly). It was so bad that I was in bed with excruciating pain, throwing up for the entire week.

    Now after 3 weeks of the stent removal, I am still in constant pain. I have missed several days of work (too much pain) and the doctor says everything looks fine (after X-rays and CT scans). They make me feel like I’m making it all up! Has a anyone else had this problem? It would be nice to know that I’m not the only one.

  2. Ricardo says:

    I had a stent removed and it was the most uncomfortable & undescribable feeling i have ever felt. Five hours after I leave Dr’s office, I start getting pain in my back and soon the pain/iching/ burning feeling on my groin with the feeling of always having to pee. Lasts for about 1 hour then goes away. Now everyday i get the same pain once a day, usually in the afternoon. Just talked to my doctor and he told me it could just be debris or old blood passing through ( i did see some dry blood coming out). As long as I don’t have a fever and constant pain, he’s not worried, drink a lot of water, he said. I hope this pain goes away, because it is the longest hour i have ever been through. I can deal with the burning, but this pain is to much. Will keep updating…hope it helps someone, because the posts before me kept me from going to ER again, since my doc didn’t warn me about this….

    • Eneida says:

      Going thru the same, no warning after removing stent that I would still be experiencing any level of discomfort or pain. And now here I am, left to wonder if there is something else wrong? Is this normal or not? Pain in kidneys, lower back and bladder spasms. Plus the horrible burning when trying to urinate. I guess, I am to blame for assuming it would all be over after the stent came out. Not so!

  3. Hannah says:

    I had a stent with string placed in my left kidney and bladder after laser removal of numerous small stones encapsulated in kidney. One small stone got stuck in my ureter and did not pass for another two weeks after surgery. My stent was removed after 4 days in doctor’s office. I had taken a pain med in anticipation of some modest cramping. Removal was quick and painless. But I felt “blocked” and unable to urinate after procedure. They sent me home without any further warning but severe pain began on my way home. I already had taken pain med so I could not take any more. I was scared about increased bloating and urge to pee without getting any release. Nurse had me return to office and I spent one night in hospital for observation + pain management. I felt very achy with burning and bleeding for 2 weeks until I felt normal again. Agreed: doctors must treat stent removal with adequate after care and pain management and should not send patient home without observation. Why do we have to suffer so unnecessarily?? I took a lot of bed rest and was lucky I had some holidays available for recovery.

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