Is painful urination concerning after kidney stone removal?

Question

Hi doctor,

I had a kidney stone procedure yesterday, during which a stent was inserted. Right after leaving the surgery center, I experienced horrendous pain that was just as bad or worse than the stone pain. I was admitted to the ER (emergency room) last night, and a CT scan revealed damage and a hole in the ureter. Urine is pooling around my kidney and the surrounding area. The more fluid I drink, the more pain I experience, and urination is very painful. What is the best course of action? There is a history of complications following a procedure with a ureter leak. The current medication being taken is Percocet. Recent lab tests conducted at the ER include blood work, urine analysis, and a CT scan, with the relevant documents uploaded. Is this a common occurrence after this type of scope? The pain is being managed at this point, but I do not want to mask something that could get worse.

Answer 1

Hello,

We welcome you to icliniq family.

I am so sorry to hear about your troubles. Let me start by saying that things will get better, and you are not in a life-threatening situation. However, I need you to share a couple more details so that I can provide you with better advice:

How large was your initial stone that was treated?
Was the stone located in the kidney or the ureter? (It would be helpful if you could share your pre-surgical computed tomography scan report with me.)
What type of procedure was performed for you? Did they access the stone from below, that is, through your urethra via a ureteroscope, or from above, that is, through your flank via PCNL (percutaneous nephrolithotomy)?
Are you diabetic or hypertensive?
Have you undergone any other surgeries in the past?

From my interpretation of the scan, I believe there is a small rupture in your kidney rather than the ureter, and some amount of fluid (which was used during the surgery) has leaked into the surrounding area of your kidney. This is a known complication of stone surgery and generally occurs in 2 to 5 percent of patients. However, the good thing is that the stent is in position and will protect your kidney and aid in its healing. The only thing is that the stent will need to be left in place for slightly longer than what we would for someone who did not have this complication. But with time, in 6 to 12 weeks, your kidneys should return to normal. Currently, you have some elevated blood values (which indicate an infection), and I would recommend that you be on IV (intravenous) antibiotics for a few days, followed by oral antibiotics for a few weeks.

Please reply with the details, and I will do my best to assist you with any further questions that you may have.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Thank you for providing as many details as you could. As I mentioned before, this is a known complication of endoscopic stone surgery, occurring in around 2 to 5 percent of patients. With time, it will settle down and will not have any negative effect on your kidney. The only thing I would recommend is to leave the stent in for 6 to 12 weeks to enable complete healing of the ruptured area. This practice varies among doctors, so I would recommend you discuss it with yours. The pain you are describing is related to the stent. When your bladder is full, the end of the stent hangs in the bladder. As soon as you empty it, the end of the stent hits the wall of your bladder, causing a sharp pain in your loin or at the tip of your penis. This is very normal, and I generally tend to prescribe alpha blockers and bladder relaxants to reduce stent-related symptoms. Please discuss this with your doctor as well. Once again, let me assure you that things will get better with time.

Please let me know if there is anything else I can assist you with.

Thank you.