Is persistent flank pain 2 days postoperative stent removal, requiring frequent doses of Percocet (oxycodone) 5mg and ibuprofen 600mg, with a history of taking Ditropan ER (oxybutynin) once daily, a normal expectation for postoperative pain management?

Postoperative Pain Management After Ureteral Stent Removal

Direct Answer to Your Situation

Your level of pain requiring around-the-clock opioid use 2 days after stent removal is NOT typical and warrants urgent medical evaluation, not dismissal to the emergency room. 1 The urologist's office response represents inadequate postoperative care management, as persistent or escalating flank pain can signal serious complications including ureteral injury, obstruction, infection, or retained stone fragments that require prompt urological assessment—not emergency department triage. 1

What Pain Level Should Be Expected

• Normal postoperative course: Most patients experience mild to moderate discomfort for 24-48 hours after stent removal, manageable with scheduled NSAIDs and occasional opioid use. 1
• Your situation is abnormal: Requiring 8 of 10 Percocet tablets in 2 days, needing doses every 4 hours (more frequent than prescribed), and persistent severe flank pain indicates either inadequate pain control OR an underlying complication. 1
• Red flag: A sudden increase in pain, especially localized to the kidney/flank area, requires urgent comprehensive reassessment for postoperative complications such as ureteral perforation, obstruction, bleeding, or infection—even without fever or UTI symptoms initially. 1

Your Pain Management Regimen Assessment

Your current regimen is suboptimal and not following evidence-based guidelines:

• Multimodal analgesia should be the foundation: You should have been prescribed scheduled (around-the-clock) ibuprofen 600mg every 6 hours or 400mg every 4-6 hours as the baseline, NOT as-needed. 1
• Opioids should be rescue only: Percocet should be reserved for breakthrough pain uncontrolled by the scheduled NSAID regimen, not the primary analgesic. 1
• Your self-adjustment shows good instinct: Splitting the ibuprofen dosing (200mg with Percocet, then 400mg 3 hours later) demonstrates you're trying to maintain steady NSAID coverage, which is correct—but this should have been prescribed as scheduled dosing from the start. 1

Regarding the Office Response and "Patient Abandonment"

The urologist's office response is clinically inappropriate:

• Postoperative pain management is the surgeon's responsibility: The operating surgeon or their designated coverage is responsible for managing postoperative complications and pain control, not the emergency department for routine postoperative issues. 1
• Escalating pain requires surgical evaluation: Directing you to the ER for worsening postoperative pain without first evaluating for complications represents a failure in continuity of care. 1
• Appropriate response would include: Phone assessment of your symptoms, consideration of imaging (renal ultrasound or CT) to rule out obstruction/hematoma, adjustment of your pain regimen, or arranging urgent office evaluation. 1

What You Should Do Immediately

Contact the on-call urologist directly through the hospital operator or answering service:

• Bypass the office staff and speak directly with the covering physician
• Clearly state: "I am 2 days post-stent removal with escalating flank pain requiring opioids every 4 hours, which is concerning for a complication"
• Request either: urgent office evaluation, telephone consultation with medication adjustment, or orders for imaging to rule out complications 1

If unable to reach on-call coverage, then proceed to the ER, but:

• Request the ER physician contact the on-call urologist for consultation
• Expect imaging (likely CT urogram or renal ultrasound) to evaluate for obstruction, hematoma, or ureteral injury 1

Proper Pain Management Protocol You Should Have Received

Evidence-based postoperative pain management after urological procedures:

• Scheduled NSAIDs as foundation: Ibuprofen 600mg every 6 hours (or 400mg every 4-6 hours) scheduled around-the-clock for 3-5 days, not PRN. 1
• Opioids for breakthrough only: Oxycodone 5mg every 4-6 hours ONLY for pain uncontrolled by scheduled NSAIDs, with expectation of using ≤3-5 tablets total over 2-3 days. 1, 2
• Reassessment protocol: Pain should be reassessed within 24-48 hours, with any increase triggering evaluation for complications, not just more opioids. 1
• Ditropan (oxybutynin) role: This addresses bladder spasm/urgency but does not provide analgesia for flank pain. 1

Common Pitfalls in Your Case

• PRN-only prescribing: Giving both ibuprofen and opioids as "PRN" leads to inadequate baseline analgesia and excessive opioid use. 1
• Insufficient quantity: Only 10 opioid tablets may be appropriate IF multimodal analgesia is optimized, but not when NSAIDs are also PRN-only. 1
• Dismissing escalating pain: Your pain trajectory (requiring more frequent dosing, consuming 80% of pills in 2 days) should trigger clinical reassessment, not refusal of care. 1
• No functional assessment: No one asked about your ability to urinate comfortably, ambulate, or perform activities—functional outcomes should guide pain management. 1

What Should Happen Next

Immediate medication adjustment (once complications ruled out):

• Ibuprofen 600mg scheduled every 6 hours for 5 days (not PRN), maximum 2400mg/24 hours 1
• Oxycodone 5mg every 4-6 hours ONLY for breakthrough pain uncontrolled by scheduled ibuprofen, limited to 5-10 additional tablets 1, 2
• Continue Ditropan ER as prescribed for bladder symptoms 1
• Reassessment in 24-48 hours, with clear instructions on when to call (fever, inability to urinate, worsening pain despite medication) 1

Your pain should improve daily: If pain plateaus or worsens despite optimized analgesia, imaging is mandatory to exclude complications. 1