From the Guidelines
Norco (hydrocodone/acetaminophen) may be used for pain management in a suspected ureteral injury when NSAIDs are contraindicated, but prednisone is not typically indicated for this condition. For outpatient management, Norco 5/325 mg taken every 4-6 hours as needed for pain would be reasonable, not exceeding 4000 mg of acetaminophen daily 1. However, suspected ureteral injuries generally require prompt urological evaluation and often need imaging studies like CT urography to assess the extent of injury, as recommended by the WSES-AAST guidelines 1.
Pain control alone is insufficient treatment, and ureteral injuries may require procedural intervention such as stent placement or surgical repair depending on severity. While Norco addresses pain by binding to opioid receptors in the central nervous system, it doesn't treat the underlying injury. Prednisone, a corticosteroid typically used for inflammatory conditions, has no established role in ureteral injury management.
The patient should be advised to:
- Seek immediate urological consultation
- Maintain adequate hydration
- Monitor for signs of infection (fever, increasing pain)
- Watch for hematuria or decreasing urine output, which could indicate worsening of the condition
It's essential to note that non-operative management (NOM) may be considered for hemodynamically stable patients with minor to moderate ureteral injuries, but this approach requires close monitoring and prompt intervention if complications arise 1. In cases of severe injuries or hemodynamic instability, operative management (OM) is often necessary 1.
Given the potential for serious complications and the need for prompt evaluation and treatment, it's crucial to prioritize the patient's morbidity, mortality, and quality of life outcomes when managing suspected ureteral injuries.
From the Research
Ureteral Injury Management
- The management of a suspected ureteral injury in a patient who cannot take Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) is crucial to prevent further complications.
- According to a study published in 2000 2, the use of prednisone in combination with other medications such as nifedipine XL, trimethoprim/sulfa, and plain acetaminophen resulted in higher stone passage rates and fewer lost work days, emergency room visits, and surgical interventions.
Pain Management
- For patients who cannot take NSAIDs, alternative pain management options such as opioids and acetaminophen may be considered.
- A study published in 2018 3 mentions that opioids and acetaminophen are currently accepted pharmacological therapies to mitigate the symptoms of ureteral obstruction.
- However, it is essential to note that opioids have their own set of risks and side effects, and their use should be carefully monitored.
Use of Norco and Prednisone
- Norco (hydrocodone/acetaminophen) and prednisone may be effective for outpatient management of a suspected ureteral injury in a patient who cannot take NSAIDs.
- The use of prednisone has been shown to be beneficial in reducing inflammation and improving stone passage rates 2.
- However, the use of Norco should be carefully considered due to the potential risks associated with opioid use, especially in patients with chronic kidney disease (CKD) 4, 5.