From the Guidelines
For a 65-year-old female with severe flank and right-sided abdominal pain after recent ureteral stent placement, immediate evaluation and intervention are crucial to prevent further complications and improve quality of life. The patient's symptoms suggest potential stent-related complications, such as migration, obstruction, or infection, which can significantly impact morbidity and mortality [ 1 ].
Initial Assessment and Management
To address the patient's severe pain and potential complications, the following steps should be taken:
- Obtain urinalysis and urine culture to check for infection
- Complete blood count to assess for leukocytosis
- Basic metabolic panel to evaluate renal function
- Order a non-contrast CT scan of the abdomen and pelvis to assess stent position and rule out migration, obstruction, or encrustation
- Provide pain management with NSAIDs like ketorolac 15-30mg IV or oral analgesics appropriate for renal function
- If infection is suspected, empiric antibiotics such as ceftriaxone 1g IV or ciprofloxacin 500mg orally should be initiated
Urgent Urology Consultation
Given the potential for stent-related complications, urgent urology consultation is warranted for potential stent adjustment or replacement if imaging shows displacement or obstruction. The consultation should focus on evaluating the need for stent revision or removal, as well as addressing any underlying issues that may be contributing to the patient's symptoms [ 1 ].
Ongoing Management and Monitoring
The patient's condition should be closely monitored, with ongoing assessment of pain, renal function, and potential complications. Hydration with IV fluids is important, especially if the patient has decreased oral intake. By prioritizing the patient's morbidity, mortality, and quality of life, healthcare providers can ensure timely and effective management of potential stent-related complications [ 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 urinary tract infection (UTI) or other complications related to the ureteral stent 2, 3.
Diagnostic Imaging
- Diagnostic imaging, such as CT scans, ultrasound, or MRI, may be necessary to evaluate the cause of the patient's symptoms and to assess for any complications related to the UTI or ureteral stent 4, 5, 6.
- Imaging studies can help identify conditions such as acute pyelonephritis, intrarenal or perinephric abscesses, pyonephrosis, or other complications that may require prompt medical attention 5, 6.
Treatment Options
- The treatment of UTIs typically involves antibiotic therapy, with the choice of antibiotic depending on the suspected or confirmed causative organism and local resistance patterns 2.
- For uncomplicated UTIs, options such as nitrofurantoin, fosfomycin, or pivmecillinam may be considered, while more complicated infections may require broader-spectrum antibiotics or parenteral therapy 2.
- In some cases, symptomatic treatment with ibuprofen may be considered for uncomplicated UTIs, although this approach requires further study to confirm its efficacy and safety 3.
Next Steps
- The patient should be evaluated promptly by a healthcare provider to determine the cause of her symptoms and to initiate appropriate treatment.
- This may involve diagnostic imaging, urine culture, and sensitivity testing to guide antibiotic therapy, as well as pain management and other supportive measures as needed 2, 4, 5, 6.