What are the next steps for a 65-year-old female with a recent ureteral stent (urinary tract stent) presenting with severe flank pain and right-sided abdominal pain?

From the Guidelines

For a 65-year-old female with a recent ureteral stent presenting with severe flank and right-sided abdominal pain, immediate evaluation and initiation of pain management with NSAIDs like ketorolac 30mg IV or oral analgesics such as oxycodone 5-10mg every 4-6 hours is crucial. The patient should undergo urinalysis and urine culture to check for infection, complete blood count to assess for leukocytosis, and renal function tests. A non-contrast CT scan of the abdomen and pelvis should be performed to evaluate stent position and rule out obstruction, migration, or encrustation, as suggested by the radiologic management guidelines for urinary tract obstruction 1.

While awaiting results, hydration with IV fluids is important to maintain urine flow. If infection is suspected, empiric antibiotics such as ciprofloxacin 500mg twice daily or ceftriaxone 1-2g IV should be started. The patient's symptoms and laboratory results should be closely monitored, and urgent urology consultation is warranted, especially if imaging shows stent migration, obstruction, or if the patient has signs of infection like fever or sepsis. Stent-related pain is common due to bladder irritation, ureteral spasms, or reflux of urine to the kidney during voiding, but severe pain may indicate complications requiring prompt intervention.

Key considerations in the management of this patient include:

• Prompt evaluation for infection and obstruction
• Initiation of pain management and hydration
• Urgent urology consultation for potential stent complications
• Monitoring of laboratory results and clinical status to guide further management, as outlined in the guidelines for radiologic management of urinary tract obstruction 1.

From the Research

Presentation and Symptoms

• The patient is a 65-year-old female with a recent ureteral stent presenting with severe flank pain and right-sided abdominal pain.
• These symptoms could be indicative of a complication related to the ureteral stent, such as encrustation or obstruction 2.
• The presence of flank pain and abdominal pain may also suggest a possible infection or other underlying conditions that need to be addressed.

Possible Complications and Interventions

• Ureteral stent encrustation is a common complication that can lead to obstruction and increased risk of systemic infection 2.
• High-intensity focused ultrasound (HIFU) has been shown to be a non-invasive technique to recanalize obstructed ureteral stents 2.
• In cases of ureteral diaphragmatic hernia, ureteral stenting has been used as a treatment option, with the stent being placed to relieve obstruction and reduce symptoms 3.
• The timing of ureteral stent placement is crucial, especially in patients with obstructing ureteral calculi and presumed infection, as timely stent placement can reduce the length of stay and improve outcomes 4.

Management and Treatment

• The management of malignant extrinsic compression of the ureter may involve the simultaneous placement of two ipsilateral ureteral stents to relieve obstruction and improve renal function 5.
• Urinary cultures may not always be predictive of microbial colonization of ureteral stents, and prophylactic antibiotic treatment may be necessary prior to endourologic procedures to prevent infection 6.
• The patient's symptoms and medical history should be carefully evaluated to determine the best course of treatment, which may involve imaging studies, laboratory tests, and consultation with a urologist or other specialists.