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Of note, the medication used in the study, rofecoxib (brand name Vioxx), was withdrawn from the US market in 2004 due to concerns about cardiovascular side effects and it is no longer available.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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218 Responses to Severe pain after stent removal: How often does it happen and can anything prevent it?

  1. Robin says:

    I had my stent removed about 4 hours ago. I had laser lithotripsy for a 15 mm stone that was imbedded in my ureter on May 13th. The stent caused me a great deal of grief. Felt like I was being stabbed with every step, and I walk 10 – 12 km a day at my job. The flank pain is pretty intense right now from the removal. There was some blood when I urinated about an hour ago. I took 2 Advil when I got home at 4 pm which did not even remotely alleviate any of the pain. I just took a Dilaudid, praying for some relief. I found this site and read all the comments to find out what to expect for length of time in pain after stent removal. Looks like it varies greatly. I have an unusually high tolerance for pain. I would definitely rather take ibuprofen than an opiate but this pain is unrelenting. I will try and post tomorrow as to how long the pain continues.

  2. Amy Cameron says:

    Hi Everyone.

    I’m sitting here in pure anticipation of any pain from the stent removal may do to me. It was one to take out myself. That part is fine. I JUST pulled it out a half hour ago. I’m kicking myself for not grabbing my extra hydrocodone prescription first.

    The unknown is the worst. This was my first lithotripsy (13mm) stone. The lithotripsy didn’t work so they “scooped” them all out several nights ago. Whoever said you recover in 24 hours needs to be found and killed lol.

    They left the stent in because although most were removed, the beating my ureters took in one week has me swollen. They didn’t want to risk another blockage because ‘the ureter are closed to tight from agitation.

    Pain. Awwww. The first litho they had me on percocet that did NOTHING. Went to er where they gave me fentanyl in an IV drip. Then prescribed oxycodone (it’s percocet, minus the tylenol) so I could take higher doses without any worry of to much Tylenol.

    I’m no drug pusher, BUT you have pain meds for a reason. I started to take 15 mgs at a time instead of 5mg and it helped. A Lot. Do not wait until pain starts like I JUST did lol.

    The have pills for the bladder spasms too. TAKE EVERYTHING they recommend. Also If you are in so much pain, let the ER give you an IV to stabilize the pain. Also call your doctor if unbearable.

    This has been the most exhausting 2 weeks of my life. Drink water of course. Heating pad, take as much pain pills that your doc oks.

    Sorry. Everyone is going through this. The “surgery expectations” guide is a fraud. It’s really painful and annoying.

    TRY not to worry. I say that as I’m worried lol. I think I’ve gone through the worst.

    Praying I don’t have some wild post stent pain tonight. I will write tomorrow with update!
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    • Amy Cameron says:

      Ugh. Huggggge Mistake not taking oxycodone first. I woke up about 10 mind ago in the worst pain ever. I have a heating pad on and from what I’ve read this shouldn’t last THIS strongly for more than a couple hours. My patience got the best of me! Right now I would do anything for real pain meds. This heating pad is all I can use for now. Hunkering down!

      • Amy Cameron says:

        Hey All lol.

        Surprise I’m at the ER! At least you got a full play by play. I’m pumped full IV pain pills, which has somewhat taken the edge off.

        It simply comes down to pain management. If you have a doc give you a stent to take out at home, say NO. I really didn’t think it would get THIS bad. It’s not the stent being pulled out. That took 10 seconds. It’s the pain and intense cramping that follows about an hour later. Who knows how long this would go on… At least you can have the “good ” IV drugs like fentanyl or dilaulid right before they do it. Hopefully that will combat the pain of getting so bad that it’s passed the threshold of what vicodin or percocet can do. Which is nothing.

        I think we have to remember how fragile and delicate the ureters and kidney systems are.

        I’m happy I found all these forums. I’ve been convinced I’m this oddball with bad luck.

        No. The best relatable things I’ve read are in the comments sections. I learned all this the hard way. No one told me this could be so debilitating. Hang in there.

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