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Q1: I had a kidney stone and my doctor just placed a stent, but did not take out the stone yet. Why?
A1: An infected kidney stone can be life threatening. If a stone is blocking the flow of urine and the urine upstream becomes infected, then sepsis (low blood pressure and potential organ failure) can develop. In this case the safest course of action is to treat with antibiotics and "bypass" the stone by placing a stent. This allows the infected urine to drain around the stone. The stone is still present, but is no longer causing obstruction. Breaking up the stone or pulling it out could increase the risk of sepsis and therefore is reserved until after the infection has been cleared; usually about 1-2 weeks after the stent has been placed.
Q2: What is a ureteral stent and why do I need one after a ureteroscopic stone procedure?
A2: At stent is a plastic tube with holes throughout it used to temporarily help urine drain from the kidney down to the bladder. They are typically 20-28cm long and are very soft (see image bleow). Stone pain is due to obstruction of the flow of urine with a buildup of pressure in the ureter and kidney. After ureteroscopy the ureter will be inflamed and swollen. Sometimes the ureteral swelling will close off the ureter and block the flow of urine causing pain similar to (or worse than) when the stone was present. The stent keeps the ureter open and the urine flowing until the inflammation and swelling resolves.
Q3: Why does the stent make me have to urinate so frequently?
A3: There are two "pigtail" curls on the stent, one in the kidney and one in the bladder. The curl resting in the bladder will irritate the lining of the bladder and trigger spasms. Bladder spasms give the patient the severe and immediate urge to urinate. Male patients sometimes experience pain at the tip of the penis associated with bladder spasms. Your doctor may prescribe medications to help control bladder spasms after your procedure.
Q4: Are there any medications that can help with my stent discomfort?
A4: Yes. There are several medications that can help, however, until the stent is removed there will always be some discomfort. A medication called Pyridium can help control stent pain. It is taken 3 times a day and should not be taken for more than 3 consecutive days. A side effect of this medication is the urine becoming a bright orange/red color. A class of medications called Anticholinergics can help control the bladder spasms and overactivity associated with a stent. Examples of these include: Ditropan (oxybutynin), Detrol, Vesicare, Enablex, Sanctura, and Toviaz. Side effects of these medications include dry mouth and constipation.
Q5: Is there anything else I can do to help relieve stent discomfort?
A5: Stay hydrated and sure your bowels are moving. Many of the pain medications you received before and after your procedure can cause constipation. Your bladder will be more irritated when you are constipated because the colon is very close to it. Use over the counter stool softeners such as Colace or Sennakot. Two tablespoons of milk of magnesia can help as well.
Q6: How long will the stent need to stay after my procedure?
A6: It depends upon how much work needs to be done to get the stone(s) out. If the stone is impacted or the ureter needs to be dilated for any reason, then it generally stays for 10-14 days. If there is minimal trauma to the ureter, then it may only need to stay a few days.
Q7: Why do I occasionally have blood in my urine after my procedure? Is it dangerous?
A7: Several things can cause the urine to look bloody after stone procedures. Passing stone fragments, inflammation of the ureter, and ureteral stents are the primary causes. If a stent was left in place, it can irritate the lining of the bladder causing intermittent bloody urine. Activity and dehydration are the two most common causes. It may last until the stent is removed. Generally it is not dangerous to have blood in the urine. A few drops of blood will make urine look like fruit punch. You may notice dark or black speckles or pieces coming out with bloody urine - these are blood clots and are not dangerous either. The best treatment is to increase hydration with non-caffeinated fluids. Things to be on the lookout for are the inability to urinate and fevers. If you experience either of these, then call our office as soon as possible.
Q8: Can I play golf with a ureteral stent in me?
A8: Yes. HOWEVER, be aware that increased physical activity will lead to increased stent discomfort and likely will result in increased blood in the urine. This is not dangerous. Make sure you stay well hydrated.
Q9: Can I have intercourse with a ureteral stent in me?
A9: See answer A8
Q10: I had a PCNL and there is fluid leaking around the tube left in my back. Is this dangerous?
A10: No. The tube is held in place with a small retention balloon. Sometimes the balloon blocks urine from flowing down the ureter and it will travel out around the tube. Simply reinforce the dressing. The leakage usually stops 2-3 days after the tube is removed and the incision starts to heal.
Q11: I am currently trying to pass a stone. Why do I have to urinate more frequently?
A11: As a stone gets closer to the bladder, it will irritate the bladder muscle and trigger a spasm or bladder contraction. This gives you the urge to urinate even though your bladder may not be full.
Q12: I am currently trying to pass a stone and have pain going into my groin or testicles. Why?
A12: The passing stone irritates the nerves that travel to the groin. Women may feel it in the groin or labia. Men may feel it in the groin or testicles. The pain is not originating in these areas, but feels as if it is. No specific treatment is necessary and the discomfort resolves after the stone passes or is removed.
Q13: I am currently trying to pass a stone. When should I go to the Emergency Room?
A13: If you are considering going to the ER always call our office first, even if it is after hours or on the weekend. Our physicians' assistants and on call Urologist are always available to help guide you. Specific reasons to seek medical attention are the following:
3000 New Bern Ave.
Raleigh, NC 27610