Post-op & Stent Removal

[Christophe__0]

  I am a 35 year old male that three and a half weeks ago I underwent ureteroscopic surgergy for removal of a 3mm stone lodged in my ureter. Prior to the operation, the doctor told me that there would be a stent placed in my ureter for a few days. After the surgery (that lasted over an hour) I was told that the stent would have to stay in place for about five weeks. I was told that the reason for that when the doctor tried to position the basket that would "grab" the stone, it was so tight that he punctured my ureter.
  After a while, he was able to get past the stone, break it up, and bring it out. I experienced a lot of bleeding for seven days, and really bad burning during urination after the procedure. Since I have had the stent for three and a half weeks, I haven't had too much discomfort other than right in the area where he did the "digging". The doctor said that the stone had lodged itself into and under a little flap of skin, somehow, and that it was really difficult to get out. I expressed my concern, in reference to any scar tissue that may build up as a result of the puncture, and how it might adhere to the stent, and how that might affect the removal if it was too soon. I didn't really get an answer from my doctor that I felt comfortable with.
  My questions are as follows:
  1. Was this puncture something that potentially can cause me problems in the future if it doesn't heal right?
  2. Will removal of the stent in too short a period of time upset the healing process, or "open-up" the original wound?
  3. What can I expect during the stent removal, and what should I watch out for afterwards?
  4. Should I see a different doctor for a second opinion before the stent is removed?
  Thanks so much!!
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Dear Christopher
Thanks for your questions.
Ureteral puncture occurs quite commonly during ureteroscopic and usually requires a stent.  The ureter usually heals over the stent without a problem.   I am not aware of any studies which define the critical time  of stent removal after ureteral perforation.  It would be quite difficult to have a controlled study to look at this point.   I feel  five weeks is enough time for the healing for most ureteral perforations.  A stricture ( scar tissue) could form just from you trying to pass the stone itself,  let alone the ureteroscopy and stone basketing.  This again is rare and usually is not screened for unless you  begin to have  back pain remotely from the stent removal. Stent removal is often accomplished through a flexible cystoscope in the office using local analgesia. It is moderately uncomfortable but usually not intolerable. I believe your urologist is competent to treat your stone disease.  More importantly  you are at risk for forming  more stone in the future and you need to increase your fluid intake to the point your urine remains clear as water.  If it turns yellow you are at high risk to stone formation.  Drink two large glasses of fluid before bed and a glass each time you awake to go to the bathroom.  Make these your new years resolutions.  These habits will decrease future stone complications.    
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling  (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you  may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS-M.D. MS
* Keyword: ureteral perforation, complications of kidney stones, ureteral stents

[manil]

A related discussion, stent removal was started.