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Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available.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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109 Responses to Severe pain after stent removal: How often does it happen and can anything prevent it?

  1. Lorraine says:

    Yes I to went thought the same the minute I stepped foot into my car after the stent removal I was in horrible pain and was for 3 days straight. No warning and no help from the doctors they talk to you like your insane and that the pain doesn’t exist. I almost drove myself to the ER twice I’m now in day 5 and I am still getting naseas and some pain in my Side and groin area . This was a hire lie experience and I will never allow them to put a stent in again bc it’s horrible
    Pain when taken out.

  2. Kim says:

    I removed the stent myself at home and I thought that bad enough. Within 15 minutes, however, I began experiencing excruciating, constant pain in my lower abdomen, above the groin. Two hydrocodone did nothing. After about an hour and a half of almost unbearable pain I was prepared to go to the ER to seek relief. Almost on a whim, my wife ran a hot bath and after I got in, the pain abated rather quickly. This may have been coincidental, I don’t know. In any case, I had not been prepared by the doctor or nurses in any way for the possibility of post-removal pain, which seems, in retrospect, highly irresponsible.

    • Tim Z says:

      I had a stent in which the loop part that residues in the kidney was somehow moved in to the ureter. This was the most painfully experience I ever had. I vomited twice, couldn’t urinate and was about to pass out by the time I made it to the ER.

  3. Robert says:

    i am a 45 year old male with a history of kidney stones since I was 13, (note: always in same kidney on right side, never in left). In the last five years the frequency of stones has increased to the point where now I average weekly small stones passed at home weekly measuring 2mm and less which happens two-three times a week, and every 4-6 weeks I have a urethral block causing me to seek medical intervention (stone extraction, stent placement). In short since last March I have had 36 ER visits and 5 stone extraction and stent placements and subsequent removals. I have so much irritation and scar tissue that I now must have stents removed under sedation/ twighlight sleep, not that I object as the alternative in office procedure for stent removal is just barbaric in our modern age of medicine! I have on average three weeks of hellish pain comparable to stone blockage after I have a stent removed. The amazing thing is the lack of compassion the medical community has regarding this. I have had literal arguments with ER Docs over their assessment that I should be pain free, and the ever prevalent suspicion that I must be drug seeking, ( which is amazing to suggest as my medical record can attest to my severe chronic condition). I don’t know how many people suffer after stent removals and if there is some succinct science to provide an explaination as to why this pain persist post-op, but I wish someone in the medical community could provide those of us who do suffer with a compassionate resolution. In my experience I have become used to the stone pain and the pain of hydronephrosis, but stent placements and removals are unbearable. The medical community seems to suggest that once a stone is removed and a ureter is no longer blocked, that severe pain should subside, even during stent placement and removal it is hinted that pain should be minimal. However, I do not concur and hope some day to have medical proof and reasons why this pain exists. Pain may be relative and or subjective from person to person but should never be questioned or denied. Ureteral stents are miserable and its hard to believe that we still have docs performing in office removals and at home self removing stringed stents, something has to be changed!

    • Lis says:

      I agree! My doctors office told me I shouldn’t be in pain & I didn’t need any more pain pills! Oh my! Its unbearably on call doctor listened to me!! And refilled my script! It’s burning!!! Painful!!!!

    • David Mallon Iii says:

      Something for consideration, as a survivor of many stent removals, both string and scope, ask Dr for prescription of flomax/tamsulosin…it seems to help relax smooth muscles of urinary tract (my brother’s (a doctor) explanation is that it affects the sympathetic nervous system, and will likely mess with sexual function temporarily and give you stuffy nose), and had greatly eased the kidney colic that occurs after each stent removal. A heading pad or hot water soak in the bath also works. Also, a word of advice, try to relax as much as possible during the removal despite everything you’re brain is telling you… If you tense up, you’ll feel ever segment of the stent as it comes out, just like I did this morning, big mistake. I prepared with max dose of tamsulosin and double dose of norco… If I hadn’t, I would have certainly been back in the hospital. My current issue, is urethral hyper sensitivity with clot and stone fragment passage, but getting up to try some naproxen as suggested here. Hope my suggestions help someone. PS, my side effects of the tamsulosin may not happen for everyone, so consult with your own Dr, but I gladly trade these effects for the considerable relief from the kidney colic pain I experience without it after stent removal.

  4. John says:

    Ugh, I have a stent in. It has a string to pull it out. I am now only reading/hearing about this. Wow… So, I am going to prep and take an NSAID beforehand and hope I don’t get pain. What antispasm medicine could I suggest to a doctor to prescribe as well?
    I’m reading that opiates don’t seem to help much, yah?
    I am actually more keen on just pulling the string out myself Sunday or Monday, verses going back to the doctor’s office Tuesday.
    This is very much freaking me out.

  5. Andy Wallace says:

    Hi fellow pain sufferers had stone removed 30th dec stent fitted had stent removed 31st Jan some pain first day now 3rd February and pain is back with a vengeance despite asking was not warned about this thanks to this site I now know this is normal taken Tramadol and waiting for it to kick in as I am in agony as you all know hears hoping this wont last will let you know if I don’t kill myself first

    • Anonymous says:

      Went to the ER on Sunday for excessive vomiting and pain. Xray showed stone that was stuck. Had a 5mm stone removed on Monday , and a stent place internally. Went to remove stent on Wednesday. The doctor did not give me any forewarning on how to prepare. Was not given anything, and stent was pulled out. The thought was more traumatizing than anything. I believed the worst was over. The doctor suggested, “that if I want, I should pick up some Alieve on the way home, but don’t go crazy trying to get it”.

      15 minutes after leaving the pain set in. I was driving home and did not know if I would make it. Once home, the pain got worse. I took a Tramadol on the way home. When that did not work, I took a Oxycodone an hour later. Pain was severe. When medication wore off, pain was back and was even stronger. I must admit, it brought me to tears which does not happen easily. The spasms occur every few hours and last 25 minutes if your lucky and some may last up to an hour and a half. Oxycodone is the only thing that calms the pain. My reluctance to use it is my biggest problem. I do not use drugs, nor have I ever. Also rarely drink alcohol. This pain really sucks. Should have done my research sooner.

      • Tim Z says:

        I experience the same thing. The spasms and pain come and go irregularly. 3 days after my stent was removed I still have to use oxycodone in order to control the pain. it sucks cause I hate the feeling of pain drugs and their related side effects but it is the only way I am able to function.

  6. Jacqui says:

    Having read all the above comments I wanted to add my current pain following stent removal. I had one stent in for 6 weeks for a condition Medullary Sponge Kidney just diagnosed eventho it seems to be a birth defect. I had no problems with the stent as prior to that had pyelonephritis and septicaemia with bilateral large kidney stones removed as much as he could via uteroscopy in November 2014,. So I had no warning that I would experience any pain on removal of stent which had done under general anaesthetic on Monday 27 th Jan and since then increasing pain Tuesday which brought me back to hospital for morphine etc and the again been in hospital yesterday overnight severe vomiting and pain for 16 hours only relieved with Morphine IV .. I sit here now at home praying that I get no more pain but am armd with Voltarol Pr Tramadol Brufen Paracetamol and Contriflo to open up ureters …just a hellish experience which I am told is unusual ….until I found this site

  7. Janine Johnson says:

    My kidney stone was removed on a Friday afternoon; no complications. Stent was removed on Tuesday morning. The dr said I may have some “cramps” for the next few hours. Halfway home it hit me like a ton of bricks, worse pain than with the usual kidney stone attack. I had 6 hours of excruciating pain for which nothing was supposedly available. One minute it was intensely there and the next minute completely gone. I am confused and disappointed in the dr’s lack of compassion and non-preparation for my situation. I’ll know better next time.

  8. Shannie says:

    I just wanted to say how helpful this website has been to me throughout my kidney stone ordeal. After countless f-bombs, multiple ER visits, one surgery to get a stent in, finally having another surgery on both kidneys to remove 15 stones, (one whopper was 1 centimeter…Caught me a marlin!) enduring a week of two painful stents and peeing blood every ten minutes, I finally am not wishing for immediate death. However, I was so surprised today when I had both stents removed to find myself back in excruciating pain in my right kidney and also the lower groin area. Seriously, Why would they not warn us about this possibility that seems more like a probability? Thankfully my pain only lasted about 5 hours, but it hurt like a mofo. I took 2 800 mg ibuprofen and 2 hydrocodone….it did nothing for me. I have been in bed with a heating pad too. I’m not sure what finally helped me, and I really hope the pain doesn’t return. But I appreciate all the comments on here to help me realize what I was feeling was common. And to all of you still in pain, hoping for answers and relief, just trying to endure this terrible experience that unfortunately unites us, May God speed you through it. XO

    • g lawson brown says:

      Just had stent removed this morning and now 8hrs post removal I am about to pass out due to a pain scale of 12. As this is not my first rodeo I maxed out my narcotic doses on everything I have and have seen no relief of any kind with regards to my colic pain. In this day and age there has to be something we as chronic stone manufacturers can do .

  9. Lousalsa says:

    16 jan 14:13 UK Guildford

    I had my stent out yesterday after 3 weeks of horrible pain they finally took it out, i had a couple of hours of pain initially, slept during the night and was discharged this morning…within two hours i am in agony with severe sickening pain to my lower back…hideous….oh god…after being in hospital for 12 days after pcnl cause of pain they then put the stent in…and stone got stuck in stent so after 8 days i went to a&e kept overnight and doc said they could not take stent out and gave me tabs…i went another 19 days with the most horendus pain(u know what it is like guys)…so i was right that the stent and stone was causing all the pain…disgusting they did not take out sooner……
    But what to do now?.? Have a hot water bottle to the back and taken a painrelief..

  10. meghan says:

    hi
    my heart does go out to the people that do deal with stent removal pain I was diagnosed with MSK (medulary sponge kidneys )6 months ago it is a birth defect that usually does not come out until you were 20 to 30 almost 40 years old I will be dealing with stone removal and stents for the rest of my life what happened is the kidney looks like a sponge and at the end of the tubular is there are cystic collect urine and cause multiple stones up to 60 in a cluster that have to be removed then there will be a stent placed this is supposed to happen every 12 to 18 months for the rest of my life also dealing with multiple kidney and urinary infectionss about 5 to 6 month so yes this is a very painful procedure is very painful thing to go through the stones are very painful…..

  11. Mari says:

    My heart breaks for you Sue and all that you and your family went through,I’ve been in agony for 2 weeks now,started before Christmas 2014 and ended up in the ER twice just because they thought they had my pain under control but didn’t and let me go too soon before my scheduled out patient surgery which turned into in hospital surgery.I suffered for days after surgery with my stent and when I went in to see my doctor to have it removed I had fever,fast heart rate and pulse signs of infection,after the removal serious serious pain,called the doctors office back and the nurse was like you need to wait 24 hours and acted like I was being a big cry baby,I’ve had two children induced no pain meds worked and was in labor both times for 20 hours so I’m not such a big cry baby but this pain like nothing else,sorry to say I took 3 hydrocodone within 2 hours and finally have some relief as well as the antibiotic they gave me,I wasn’t advised to take that many but did not know what else to do.Im just dreading if the pain comes back and how bad it will be? All I can say is I’m just trying to hang on,Please Lord to help me.

  12. psy says:

    went to an EMERGENCY ROOM – really bad experience , was told by a nurse ? that they did not have stone blasting – ended up with a stent – looks like that was one of several mistakes . have always known that medical care is 99% up to the patient ; but I failed miserably .

  13. Irene McKim says:

    Hi Everyone!
    My heart goes out to all of you experiencing pain from this procedure. The same thing is happening to my husband. Thank you for sharing what you are going through, because it helps us in determining what our next step is in resolving his pain. We are going to see his main doctor this afternoon, and hopefully he can at least tell us if the pain is because of the remaining stones that need to be passed. We just want to be sure it’s not something else happening. If only the doctor would communicate better on what to expect, we would be ok with that. But nothing was said. grrrr Take care everyone. xoxo

  14. jill says:

    no warning was given to me about pain after the removal of the stent. About an hour later I was doubled over with the worst pain ever. very frightening. took painrelief and about 2 hours later it faded away. hopefully not to return…..

  15. Chris keely says:

    I had my urethral stent removed at 11am today. No warning about the possibility of pain from spasms. Within 15 minuets of leaving it began. Started in the left front and moved around to my left kidney. This pain got so bad I didn’t think I would make it home. This was the most pain I have experienced so far. I made it home and took 2 hydrocodons , a nausea and a spasm pill i was given from the surgery a week ago. In one hour it finally stopped. It is now 12 hours later and the whole process is repeating. I have repeated the pills except only one hydrocodon . 1/2 hour later and pain is going away. The spasm pill seems to be the pill that helps. This should have been given at the removal and not later when you think you are about to pass out from pain. Consult your doctor before you have the stent removed and avoid this common side affect they don’t tell you about. I still don’t know how long these spasms will last.

  16. 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.

    • Ben says:

      It’s a bit late now but I hope you or someone else might find this useful info. As this is my first stent, my advice should be taken cautiously. The night after surgery I hardly slept from severe stinging during urination and flank pain which made me fairly nauseated :( My urine turned dark tea colored for a brief period at height of pain and total output was low. By morning, I began to drink more fluids and the more fluids I got in the more the pain lessened. I now, 2nd night in, only have mild discomfort in the kidney from limited water intake during sleep. BTW, going back to normal activities seems to greatly increase kidney discomfort and blood in urine vs resting. I drove my car for about 10 min, and that seemed too much. Aside from high water intake my ketorolac (anti-inflammatory) seems to help with the pain and Percocet is a little more effective than oxycodone alone. I hope I don’t get the pain following removal.
      God bless,
      Ben

      • Heather says:

        I just had surgery to remove a 5mm kidney stone and several other 4mm stones from my right ureter and kidney on friday3/20/15. I am supposed to take my stent on thursday the 26th. This is thr first time I have not been able to pass my stones and have surgery with stent placement. The stent pain is extremely uncomfortable, im grateful that my pain is mostly relieved with hydrocodone and a urinary tract analgesic. I too have noticed that drinking more water helps alleviate the pain when I cant take anymore hydrocodone at the time. I have only been drinking water as I have made the mistake of drinking just a few swallows of soda and put myself in excruciating pain. I am dreading the removal of the stent (mine is threaded for self removal at home). Also, a hot bath is a HUGE help as well….it relieves my pain some and (as gross as this sounds) it helps me to pass more urine, I guess from the heat relaxing the muscular tissues of the ureter and urethra,because I always feel like im not fully done urinating without climbing in a hot bath. Good luck to everyone!

  17. 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

  18. 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.

  19. 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.

  20. James says:

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

  21. 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

  22. 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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