Postoperative Instructions For Ureteroscopy, Laser Lithotripsy, Stone Extraction 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.

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 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. 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. 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. Take as directed. This helps relieve bladder pain. This turns urine and body fluids orange.
• Oxytrol patch (oxybutynin): Over-the-counter. This helps ease frequent urination and bladder spasm. Take as directed. This can be used in women and men.
• Tamsulosin (Flomax): This may 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 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.

Stent removal

The stent is typically 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 acetaminophen (Tylenol) tablet before coming to your postoperative appointment if you’d like. You may drive yourself to and from cystoscopy stent removal in the office. The stent is temporary and must be removed 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 resume normal diet and activity. Be sure to drink plenty of water.

Postopeartive appointment

Call the office to make an appointment for follow up if you do not already have a postoperative appointment.

Call the office for

• Fever over 100.5 degrees Farenheit, vomiting or uncontrolled pain