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Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available.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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338 Responses to Severe pain after stent removal: How often does it happen and can anything prevent it?

  1. Mandy V says:

    I took my stent out myself past night and while the removal itself didn’t hurt, I woke up in the middle of the night with severe kidney discomfort. NSAIDS havent helped, only the strong pain medicine they prescribed. Still feel like i need to pee frequently and urethra is still irritated.

  2. Joanne says:

    My hubby had his stent removed today got home and he is sweating and in so much pain he can’t even sit down, keeps being sick what do we do x

  3. Mohammed khaja pasha says:

    I removed my dj stent today from left kidney. I am now experiencing a burn pain at left kidney and pain while urination..
    I want to knew how much duration it take for being normal. And I got discharge summary same day

  4. David W Carolla says:

    I went to ER at 11:00 PM 09/11/17 with the worst pain I have ever experienced and I’ve had 45 orthopedic surgeries. Turns out it was a 1.8 CM kidney stone. They called in a urologist and I had emergency surgery at 4:00 AM 09/12/17. The stone was so dense they were only able to get half of it broken up. They put in a stent and I have to have another surgery to finish the procedure. Still waiting for the call from the Dr for the follow up. Still peeing blood day two and still painful.

    • Angela Bauer says:

      I had my kidney stone broken up also, now I have a stent. It has been one week and I have had horrible pain, and still peeing blood after a week. I can’t wait to get this stent out, but now I’m wounding how much pain I will be in after the stent is taken out😢

  5. Glenn and Beverly says:

    A month ago my wife had her gall bladder out and Xrays showed a larger than average kidney stone not yet dropped from the kidney into the urinary track so they scheduled to have her come in to receive a stent and blast the kidney stone 3 weeks later.

    The surgery went fine but the surgeon could not find any kidney stone. That was interesting to say the least! ( after all he said it was larger than the average stone)
    So they left the stent in for 3 days and had her come back into the Doctors office to remove the stent as it was somewhat painful and was on pain medication for it, however… about an hour after she came home she started crying in pain and bent over even on prescribed pain medication.

    Back to the emergency room we went where they prescribed oxi cotton.. (excuse spelling)
    That helped the pain but it is 3 days later and she is still has to take prescribed pain medication.
    Why in the _____ these Doctors don’t tell you that there is a good possibility of severe pain. I thought they screwed up the surgery or ripped or punctured something the pain and length of pain being so bad. I was ready to take her to another hospital but after reading all the reports from others experiencing very similar issues I settled down to the fact that it is what it is…

  6. Christina Graham says:

    Had a stent removed from left ureter on Monday, 7-31-17 out patient surgery ! Tried to do in office on 7-28-17 by Urologist who end up doing three cystos and could not do the procedure, I was crying and screaming in pain. Decided to take out on that following Monday 7-31-17. The burning is 10+ and I’m on Tylenol extra strength, as I am allergic to codeine ! Warm baths make it worse. what can I do to help stop the burning pain !! I have Multiple Sclerosis and stress can make a flare up happen. I am 65 yrs old .

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