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Keywords:

  • ureteroscopy;
  • stents;
  • urolithiasis;
  • NSAIDs

What's known on the subject? and What does the study add?

  • The problem of severe pain after ureteric stent removal, its incidence and prevention, has not been previously described.
  • The present paper is the first to determine the incidence of severe pain after ureteric stent removal. It also shows that a single dose of NSAID before ureteric stent removal can prevent this pain in a significant number of patients.

Objectives

  • To determine the incidence of severe pain after ureteric stent removal.
  • To evaluate the efficacy of a single dose of a non-steroidal anti-inflammatory drug (NSAID) in preventing this complication.

Patients and Methods

  • A prospective, randomised, double-blind, placebo-controlled trial was performed at our institution.
  • Adults with an indwelling ureteric stent after ureteroscopy were randomised to receive either a single dose of placebo or an NSAID (rofecoxib 50 mg) before ureteric stent removal.
  • Pain was measured using a visual analogue scale (VAS) just before and 24 h after stent removal
  • Pain medication use after ureteric stent removal was measured using morphine equivalents.

Results

  • In all, 22 patients were enrolled and randomised into the study before ending the study after interim analysis showed significant decrease in pain level in the NSAID group.
  • The most common indication for ureteroscopy was urolithiasis (14 patients).
  • The proportion of patients with severe pain (VAS score of ≥7) during the 24 h after ureteric stent removal was six of 11 (55%) in the placebo group and it was zero of 10 in the NSAID group (P < 0.01).
  • There were no complications related to the use of rofecoxib.

Conclusions

  • We found a 55% incidence of severe pain after ureteric stent removal.
  • A single dose of a NSAID before stent removal prevents severe pain after ureteric stent removal.