Postoperative Instructions for Cystoscopy and Stent Placement

Diet

After anesthesia, begin with clear liquids. Avoid heavy meals on the day of the procedure. You may resume your normal diet. Drink plenty of water. Goal fluid intake is three liters or 100 ounces daily. In the short-term this will help flush the urinary tract. In the long-term this will help prevent new kidney stones from forming.

Activity

You may resume your normal activity. You may shower or bathe as you normally do. There are no activity restrictions. The more active you are, the more blood you may see in the urine. This is expected and is not cause for alarm.

Ureteral stent

A stent is a long, thin plastic tube that runs from the kidney to the bladder. It allows the kidney to continue draining during normal postoperative swelling. It protects the kidney from swelling and infection. Without it, it is likely you would have kidney stone symptoms. While the stent is in place you may have blood in the urine, bladder pressure or pain and frequent urination. You may see blood, clots and debris in the urine as long as the stent is in place. The more active you are, the more blood you may see in the urine. You may feel a sensation of needing to get to the bathroom right away. You may have pain in the back or side. This may be worse with urination. All of these symptoms are normal while the stent is in place. Symptoms are different for each person; some people have all of these symptoms, some have none.

Managing stent symptoms:

• Drink plenty of water. Goal fluid intake is three liters or 100 ounces of fluid daily.
• Avoid constipation. Anesthesia and prescription pain medicine can cause constipation. Constipation makes stent pain worse. You may use over the counter MiraLAX, milk of magnesia, docusate (Colace), senna (sennaGen, Senokot), Dulcolax (bisacodyl). You may use over-the-counter suppositories [such as Dulcolax (bisacodyl)] or enemas (such as Fleets).
• Soak in a warm tub or shower.
• Heating pack or ice pack over the back or bladder.
• BenGay/IcyHot/Salonpas: Over the counter cream, patch or spray. Use as directed. May apply to the skin over your back or bladder.
• Acetaminophen (Tylenol): Over the counder pills. Take as directed or every six hours while awake. Do not take more than 3000 mg of acetaminophen per day. Prescription pain medicine may contain acetaminophen as well. This counts towards the maximum dose of 3000 mg of acetaminophen per day. Avoid if you have liver problems.
• NSAIDs (ibuprofen, Motrin, Advil, Aleve): Over the counter pills. Take as directed. May be combined with acetaminophen (Tylenol). Avoid or use with caution if blood tests show low kidney function or if you have chronic kidney disease or stomach ulcers.
• Azo (Urinary Pain Relief, Pyridium, phenzaopyridine): Over-the-counter pills. Take as directed. This helps relieve bladder pain. This turns urine and body fluids orange.
• Oxytrol patch (oxybutynin): Over-the-counter patch. This helps ease frequent urination and bladder spasm. Take as directed. This can be used in women and men.
• Tamsulosin (Flomax): This medication be prescribed by your provider. This helps relax the urinary system. It can help pass stone fragments and ease stent pain. Take this once or twice each day. Stop, decrease or take before bed if it makes you dizzy.
• Narcotic pain medication: This medication may be prescribed by your provider. Take as directed if you have pain despite the above measures. Narcotics can cause addiction, stomach upset, dizziness, confusion and constipation. Opiod abuse is a national epidemic. Be sure to dispose of unused medication once your surgical care is complete to protect your family from exposure.

Postoperative plan

If the stent was placed for a kidney stone, you will need another surgery to treat the stone. Call the office to make an appointment to plan stone treatment.

Stent removal

If the stent was placed for a kidney stone, it can only be removed once your stone treatment is complete. Be sure you check with your surgeon on when it is safe to remove the stent. Stents are often removed 5-14 days after your last stone surgery. The stent is typically removed in the office with a procedure called cystoscopy. This involves placing a small camera in the bladder, grasping and removing the stent. The procedure usually takes only a minute or two and is typically uncomfortable but not very painful. You may take an over-the-counter ibuprofen or acetaminophen (Tylenol) tablet before coming to your stent removal appointment if you’d like. You may drive yourself to and from cystoscopy with stent removal in the office. The stent is temporary and must be removed or changed within three months.

After stent removal

You may see blood or debris in the urine for a day or two. He may have burning with urination for a day or two. You may have stent symptoms for a day or two. You may use the measures mentioned above to manage stent symptoms. You may resume normal diet and activity. Be sure to drink plenty of water.

Stent exchange

If the stent was placed for kidney swelling, it is typically exchanged in the operating room in three months. Call the office to make an appointment to discuss stent exchange.

When to call the office

Fever over 100.5 degrees Farenheit, vomiting or uncontrolled pain