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Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available.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.
This entry was posted in Information. Bookmark the permalink.

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

  1. Jorge Pedraz says:

    I had 19 mm stone removed from my right kidney using Laser on August 11, now I have a stent will be removed this coming Wednesday the 24 , after read all this comments I scared to dead .

  2. Janet says:

    Finally relief after about 2 hours. Hot, pulsating shower on flank brought almost immediate rrlief. So I’d turn it off and stand there until I needed the water again. Took 2 oxycodon about 20 minutes ago. Also: per doc’s orders, drank water — about 20 -30 oz in 10 min. Now pain free, hallelujah. Starting to feel drugged…..

  3. Janet says:

    Ow. Stent was pulled out about 3 hours ago. Pain is about at 5. Standing in shower with very warm water falling against flank relieved it. But I couldn’t stand there forever. Doc gave me a sample of hydro-something ( like Urelle). Took at first onset of pain. Don’t think it’s working. Now lying on heating pad. I hate to experiment with all the different drugs I have on hand for fear of bad reactions. Maybe will try some pyrridium after a while. Ow…

  4. man in pain says:

    I have just had my jj stent taken out about an hour ago and the pain is unbearable.

  5. Janet says:

    I’m getting my stent removed (the string kind) in a couple of hours. It’s only been in 3 days, following a surgical ureteroscopy ( no stone removal, little trauma to ureter). I had another stent in for three days prior to that because the doc couldn’t get the scope into my ureter during the first procedure. Has anyone tried pyrridium (sp?) it relieved my pain very well post op. Or do these spasms require a whole different arsenal if pain relief?

  6. Matthew says:

    Hello, I’m 7 days after removing my own stent. I am almost done my pain and anti inflamatory pills. Yesterday I had a mild flare up and didnt need to take any pills. This is really stressful just now after eating it flared up hard…. I just want someone to smash me over the head with a frying pan the pain is so bad… 25 min after taking my pills I’m feeling ok.

    Had the stent in for 5 days post op, blood in urine and burning was normal the string hanging out my penis was just annoying… pulling out the stent felt weird but thats all.. really sucks to know that once you get one chances are youll get another…

    Ill got for a followup sometime this week and figure out what the stone is composed of… Ill do anything not to have this again… the taxi was out front of my home but i said call an ambulance im not gonna make it ….

    Just thought id share… keep on trucking everyone

Leave a Reply

Your email address will not be published. Required fields are marked *