Discharge Instructions for Kidney Stone in Ureter
For patients with a kidney stone in the ureter, discharge instructions should include pain management with NSAIDs as first-line therapy, increased fluid intake, medical expulsive therapy with alpha-blockers for stones <10mm, instructions to strain urine, and clear indications for when to return to medical care. 1, 2
Pain Management
- NSAIDs (diclofenac, ibuprofen, metamizole) are recommended as first-line analgesics for renal colic due to their superior efficacy and fewer side effects compared to opioids 2
- Use the lowest effective dose of NSAIDs to minimize cardiovascular and gastrointestinal risks 2
- Opioids should be used as second-line therapy only when NSAIDs are contraindicated or insufficient for pain control 2
- Pain medications should be taken on a regular schedule rather than "as needed" for optimal pain control 2
Medical Expulsive Therapy (MET)
- Alpha-blockers (tamsulosin, terazosin, doxazosin) should be prescribed for stones <10mm to facilitate spontaneous passage 1
- MET can increase stone passage rates by 29% and reduce stone passage time 2
- Patients must be informed that alpha-blockers are used "off-label" for this purpose and counseled about potential side effects 1
- Most stones that will pass spontaneously do so within approximately 17 days (range 6-29 days) 3
Hydration and Dietary Instructions
- Increase fluid intake to 2-3 liters per day to maintain dilute urine 4, 5
- Strain all urine to recover passed stones for analysis 6
- For calcium stones, avoid excessive dietary salt and animal protein 7
- For uric acid stones, alkalinize urine with citrate supplements or increased fruit and vegetable intake 8, 7
Follow-up Instructions
- Schedule periodic imaging (preferably low-dose CT or ultrasound) to monitor stone position and assess for hydronephrosis 1, 3
- Complete metabolic testing if indicated (first-time stone formers should have stone analysis performed) 8
- Follow up with a urologist within 2-4 weeks if the stone has not passed 3
Return to Medical Care Immediately If:
- Uncontrolled pain develops despite adequate analgesia 3
- Fever, chills, or other signs of infection develop 1, 8
- Nausea and vomiting prevent adequate hydration or medication intake 6
- Development of obstruction or worsening hydronephrosis occurs 3
- Anuria (complete cessation of urine output) develops 2
Prevention of Recurrence
- Continue increased fluid intake (2-3 liters daily) even after stone passage 4, 9
- Dietary modifications based on stone composition (once analyzed) 7
- Weight management, as obesity increases risk of stone formation 5, 7
- Avoid medications that may promote stone formation when possible 7
Treatment Options if Stone Fails to Pass
- Both shock wave lithotripsy (SWL) and ureteroscopy (URS) are acceptable first-line treatments 1
- URS yields significantly greater stone-free rates for most stones but has slightly higher complication rates 1
- SWL is less invasive but may require additional procedures 1
- Blind basketing (stone extraction without endoscopic visualization) should never be performed 1
Remember that stones >10mm are less likely to pass spontaneously and may require surgical intervention sooner 1, 5.