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Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available.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 surgical approaches. He sees patients at clinics located in Los Angeles, Pasadena, and La Canada, CA. He is the founder of the www.KidneyStoners.org website.
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117 Responses to Severe pain after stent removal: How often does it happen and can anything prevent it?

  1. mike says:

    I thought I would relate my experience with a stent since this site has been very informative. It started with blood In urine but no pain….then a cystoscopy to check my bladder which was fine and then a CAT scan that showed a filling defect (a spot where the contrast would normally be seen but does not show up). The scan did not show a stone. I had a ureteroscopy and they found a 3mm stone that wasn’t visible on the ct scan. Stone was removed and a stent placed. The stent caused some moderate pain only when urinating…kind of a cramping feeling. The blood in urine continued the entire time the stent was in.

    After reading posts here I was very apprehensive about pain associated with the stent removal. Based on recommendations here I took one naproxen about an hour prior to the removal. It was removed by the urologist via a cystoscopy. This was my third cystoscopy so no apprehension about that…lidocaine into the urethra and only a little pinch as it went by the prostate. Kind of a strange feeling but no pain at all as it came out. My nerves were on edge for the next few hours as I waited for the pain to begin. I took another preventive naproxen about two hours after the procedure. I waited all evening for the pain to start but there was no pain at all. The first two urinations were still a little bloody…light brown urine…then that stopped by the next morning.

    I also had started FloMax right after the ureteroscopy for BPH so maybe that had some positive effect as well. In any event after reading some of the horror stories here I thought I would post a positive outcome. I feel bad for those who had a bad experience, but for those with a stent removal in your future, it may not it be a bad as you think it will be. I would recommed that you ask your doctor about taking a naproxen prior to the removal.

  2. Thom says:

    My doctor told me I might have some discomfort after the stent was removed. Three hours later I was back at emerg with pain worse than before surgery. This was my second surgical removal but first stent out of 14 stones. The Doc at ER said there were no more stones, which had been my first thought, and that the pain was due to inflammation of the ureter and clots of blood blocking the ureter just as a stone would. Same treatment as for the stone, pain killers and lots of fluids until it passes.Three days later I am still suffering the after effects of the stent. Have your Doctor prescribe an anti inflammatory with a pain killer before stent removal to minimize the possibility.

  3. angie says:

    Kidney pain after a stent removal….I had kidney stone removal almost 3 wks ago with stent removal a wk ago. I was put on Cipro, morphine and Diclo. The morphine made me puke, so I took Tylenol. I think like a lot of people, I am one who does not swallow all meds unless it is stressed to be important so I took the Diclo for the first couple of days after the stone removal (also the prescription said take as needed) I was ok for the 1st two days after the stent removal but then got increasing pain that Tylenol did not help with. Monday night I thought I was going to die of pain. I finally fell to sleep around 3:30 a.m.with pain coming back later (now Tuesday)around 1:00 and increasing. 5:30 I called my pharmacist to see if there was any other pain killer I could take and she commented that the anti inflammatory I was on would help more than any pain killer, except I was not taking it and since it is not written on the bottle, who remembers exactly what each pill is for! I took her advice and took one around 5:35. I suffered with 9/10 pain until 7, eventually going to the hospital. Waiting room was packed. As we were waiting, all of a sudden, almost like a switch turned off, I realized the pain was gone, I mean GONE. The moral of my story is patients need to be told by their doctor and even the pharmacist what meds they have been put on and why and what will happen it they do not. The bottles should tell you what the medication is , i.e. what it does, my case – an anti inflammatory. I looked on line everywhere for answers but found no clues so I really hope this helps anyone else that may be suffering like I was.

  4. sarah moxon says:

    I had my stent fall out the same day of my surgery hours later. Omg the pain is horrible my Dr said if it was bad enough to go to the ER.well it’s been 5 days and the spasms come and go I hope this ends soon.By the way this is my 3rd kidney surgery and I swear the pain gets worse.

  5. kristen says:

    I had litho a week today with stent placed removed stent myself which I’ve done since I was 18 I’m not 32 I pass several stones a month but every now and I have to have a little help it’s been 5 days since the Stent was removed and I’m still experiencing severe pain it’s worse then the stone pain my urologist just telss.me to go to the er but I’m not paying someone to tell me what I already know! Praying the next day or so these pains will go away it’s miserable

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