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Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available.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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85 Responses to Severe pain after stent removal: How often does it happen and can anything prevent it?

  1. Natali says:

    Just had my surgery last night to remove a 13 mm kidney stone. They put a stent in and that pain has been 10 times worse than the kidney stone have been up all night long double over trying to relieve the pain tell me what were the best things that helps you get over the pain. Hydrocodon and Percocet have not helped.

  2. faye vanasse says:

    Had my stent removed today haven 100purcent pain just like the stone dr said add motron to pain med still pain going to er if not better Wowwheeooowheeochie

  3. carin says:

    i had a stent placed on 9/6/14, had lithotripsy on 9/17/14, and thought the stent was uretheral pain? ha, no. getting the stent taken out via cystoscopy is way worse for this momma who thought she merely pulled a muscle the day before this all started. when they removed it, initially, I was in minimal pain, but I’m on day after, and I’m achy but not enough to go to the ER. so long as no one touches me I am OK, urinating is the only nonpainful experience I have as of now.

  4. Stephanie says:

    I had stents removed from both sides yesterday evening.
    It is now 2:45 am and I am doubled over in pain googling this

    I have a heating pad on high and it seems to be helping a bit but the pain is constant and unwavering. I thought I was passing another stone for sure until I read the previous post.

  5. James says:

    If you are experiencing pain after removing the Stent, run a hot bath. This immediately stopped the pain for me.

  6. Cheri says:

    Aug 18, 2014 I had surgery to blast some kidney stones in my left kidney, one week to the day I was taken via ambulance to ER, all kinds of tests plus xray and found 2 stones in the ureter 4mm & 6mm – said they will pass and sent home with narcotics for pain and nausea pills – threw up all night could not keep even water down much less pills. Back to ER and admitted immediately for surgery – stent placed and no pain until stent removal. I was NEVER advised, given a piece of paper with what to watch for — NOTHING about stent removal. Showed up removal was not bad but by the time I got to my car was beginning to double over – OMG thought another stone was stuck – several hours later, throwing up back in ER and morphine to relieve pain, tests and xrays – no stone – sent home with morphine and nausea meds – ok drink 8 oz of water every hour and take pills for pain. Today is day 5 still have pain that comes and stays – called doc – sorry no appts for a month ….”what about plan B I ask” we will call you after we chat with him. Thank goodness for all your comments. I am 69 and have passed 2 stones without anything prior to this, hip surgery and 4 children – this has been worse than childbirth by far and pain after stent removal is the same as passing a stone – does not come in waves – is steady and constant. I cannot live on morphine (which by the way does work) I have now put myself on anti inflammatory OTC and will continue until I am healed internally. Thank you for all your posts. It angers me that we are not informed and prepared for this type of pain that 55% of us experience. Share this site with all you know – wish I had seen prior to stent removal

  7. Monica says:

    I had my laser lithotripsy done on a Tuesday and the stent removal on Friday. My doctor did not prepare me for the level of pain that I would experience after the stent removal. It was definitely a 9 or 10. I literally count down the minutes t o my next pain pill, which I have now doubled up on. At this point I am relegated to either being doubled over in pain or walking around like a pill popping zombie. The pain for the stent removal is worse than the kidney stone or the surgery. I shake my head that doctors say you can resume normal activity in three days. Thankfully, a friend is a urologist and suggested taking a NSAID with the pain medication to reduce inflammation. This seems it be helping. Thank god.

    • sue says:

      Hi Everyone, I had the stent put in late July and removed this week 8th oct Ya
      to all the ladies out there Curash helped with the burning pee I went through many tubes! And as gross as it sounds Johnsons baby wipes were a god send not only did they make it so much easier to apply the curash they had a soothing affect (they are cool and soft) But of course that’s only one part of the problem. Warm baths also helped KEEP DRINKING LOTS OF WATER. Know your symptoms ….Painful pee ,Bladder spasms, kidney spasms , feeling sick ….make sure your looking at every pee check the colour ….you may have a bladder infection… Don’t go to the Dr without a pee sample. The sample containers are cheap buy a few. Write everything done medications especially so you don’t loose track… DONT WAIT FOR PAIN BEFORE YOU TAKE PAIN RELIEF!! If advised 4 hourly take it 4 hourly if its not working get back to your Dr or check over the phone with your Chemist/ pharmacist what is safe to take until you get to DR..
      I feel for all those going through this and those caring for you all it has been a terrible experience. I had the stent removal surgery they said there was no sign of a stone/s (I had a 4mm blocking the tube as it comes out the kidney and 1mm further in the kidney. They left the stent in and kept me in hospital overnight and said it would be removed in the morning…. By 10.30 that night I could tell some thing was blocking the kidney was in permit spasm it was so so painfull I was given medication after medication nothing even eased the pain I was vomiting through out by 230am a DR finally came and after calling on call Urologist I was injected in the stomach god knows what I didn’t care at that point ! They said the needle would hurt I didn’t feel it because the kidney pain was so bad. I had to have 3 of these needles before I had got the relief I was looking for. I would have signed my house over to that Dr then and there !
      It was almost like the worst labour pain only constant for 5 hours…later that morning the stent and colostomy bag was removed by mid morning I went home exhausted and slept I didn’t need as much pain relief as I thought I would but I was so so sore ,kidney sore and felt like I wanted to vomit all day but didn’t . Today I’m a little better than yesterday and have eaten a little, I feel like my ribs have been kicked in and I’m burping a lot Finally did a poo !
      (that made my day) I’m taking antibiotics forgot to mention I had 2 bladder infections…With the benefit of insight… I know now that when my pee had changed from cloudy yellow to bloody dark brown or changed in the look of what I’d been doing for weeks THAT WAS INFECTION. And you don’t want that THEY’LL CANCELLED STENT REMOVAL IF THERE’S INFECTION !!
      I WISH ALL THAT HAVE THIS TERRBLE CONDITION THE VERY BEST MY HEART GOES OUT TO YOU ALL & YOUR FAMILIES THAT CAN DO NOTHING BUT WATCH. One thing I got through to my husband and teen kids YOU HAVE TO FIGHT FOR YOURSELF OR YOUR LOVEONE WHEN IT COMES TO DR’S, HOSPITALS AND THE TREATMENT YOUR RECIEVING. My last tip is KNOW YOUR RIGHTS AS A PAITENT ITS AMAZING HOW THINGS GET MOVING WHEN YOU ASK ESPECIALLY WHEN IT COMES TO GETTING PAIN RELIEF…
      Kind Regards Sue from Adelaide Australia

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