Postoperative Instructions

Ureteroscopy, Laser Lithotripsy and Stent Placement

Diet

Avoid heavy meals on the day of the procedure. You may resume your normal diet. Drink plenty of water. The target fluid intake should be > 2.5 litres a day unless advised otherwise. In the short term, this will help flush the urinary tract. In the longer term, this will help prevent new kidney stones from forming.

Activity

You may resume your normal activity. 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. Blood in the urine is like food colouring - a small amount of blood can make the entire urine output look red. You may shower or bathe as you usually do.

Ureteric stent

A stent is a long, thin plastic tube that sits in the ureter runs from the kidney to the bladder. It allows the kidney to continue draining during normal after the procedure and helps stone fragments to pass. It protects the kidney from swelling and infection.

While the stent is in place, you may have various “stent irritation” symptoms, which include blood in the urine, bladder pressure or pain and frequent voiding. 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 urinary voiding. 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. The target fluid intake should be > 2.5 litres a day unless advised otherwise.
Avoid constipation. Anesthesia and prescription pain medicine can cause constipation. Constipation makes stent pain worse. You may use over-the-counter Movicol, Coloxyl, Dulcolax (bisacodyl) or Lactulose.
Warm tub baths or showers may be helpful
Heating pack or ice pack over the back or bladder.
Paracetamol. Take 1g every 4-6 hours (maximum 4g in 24 hours). Avoid if you have liver problems.
Anti-inflammatory medciations/NSAIDs (Ibuprofen, Celebrex, Mobic) can be over the counter or by prescription. These may be combined with paracetamol. Avoid or use with caution if blood tests show low kidney function or if you have chronic kidney disease or stomach ulcers.
Stronger pain medication: This may be prescribed by your surgeon. Take as directed if you have pain despite the above measures. Remember narcotics can cause addiction, stomach upset, dizziness, confusion and constipation, and opioid 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 or changed 1-4 weeks after your last stone surgery. The stent is temporary and must be removed or changed within three months. For stent removal, the procedure involves placing a small camera in the bladder, grasping and removing the stent. For stent replacement, the procedure is similar to the initial procedure where the stent was inserted.

After stent removal

For a day or two, you may see blood or debris in the urine, experience burning with voiding, and have stent irritation symptoms. You may resume normal diet and activity. Be sure to drink plenty of water.