Post-Endoscopic Surgery Pain: What to Expect After Ureteral Stone Removal

Urological endoscopic surgery

I underwent endoscopic surgery to remove stones this past Tuesday.
The post-operative nurse informed me that I would experience hematuria for two to three days.
Although it is now Saturday and the hematuria has almost resolved, I am experiencing pain during urination.
The pain is as follows: on Tuesday, post-surgery, urination was painful, particularly near the glans.
Initially, there was a sharp pain when I started to urinate, but the pain was tolerable throughout the process, although straining increased the pain.
Two days later, this pain decreased.
Now, four days later on Saturday, while the pain has lessened, I still experience a slight sharp pain at the beginning of urination, and I cannot strain without experiencing pain, which remains localized near the glans.
I would like to ask the doctor if this is considered a normal part of recovery after surgery.
If so, how long might this last? Is it possible that a stone has lodged near the glans, causing this pain?

Xiao Li, 30~39 year old female. Ask Date: 2016/10/08

Dr. Sun Hongshun reply Urology

Hello, it is certainly possible that a stone has moved near the glans penis, but the likelihood is low, as it should have been addressed during the endoscopy.
It is more probable that there is a small abrasion in that area causing your dysuria.
Generally, discomfort should improve within about a week.
If you continue to experience pain, it is advisable to follow up at the clinic for further evaluation.
Wishing you good health.

Reply Date: 2016/10/08

More Info

After undergoing endoscopic surgery for ureteral stone removal, it is not uncommon to experience some discomfort and pain during urination. Your symptoms, including the initial sharp pain near the glans (the tip of the penis) and the sensation of pain when urinating forcefully, are generally considered part of the normal recovery process.

Understanding Post-Operative Symptoms
1. Blood in Urine (Hematuria): It is typical to have blood in the urine for a few days following the procedure. This is due to the trauma caused by the instruments used during the surgery. As you noted, the blood has significantly decreased by the fourth day, which is a positive sign of healing.

2. Pain During Urination: The pain you are experiencing, particularly the sharp "stinging" sensation at the beginning of urination, can be attributed to several factors:
- Irritation of the Urethra: The urethra may be irritated from the passage of instruments during the procedure, leading to localized pain.

- Inflammation: Post-surgical inflammation can cause discomfort as the tissues heal.

- Residual Stone Fragments: While it is less likely, there is a possibility that small fragments of the stone could be causing irritation as they pass through the urinary tract.

3. Duration of Symptoms: Generally, post-operative pain should gradually decrease over the course of a week or two. If the pain persists beyond this period or worsens, it may warrant further investigation.

When to Seek Further Medical Attention
- Persistent Pain: If the pain does not improve or if it intensifies, it is advisable to consult your urologist. They may want to perform imaging studies, such as an ultrasound or a CT scan, to rule out any complications, such as residual stones or strictures in the urinary tract.

- Signs of Infection: If you develop fever, chills, or increased pain, these could be signs of a urinary tract infection (UTI) or other complications, and you should seek medical attention promptly.

Management Strategies
- Hydration: Continue to drink plenty of fluids, as this helps to flush out any remaining stone fragments and reduces the risk of infection.

- Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage discomfort. However, consult your doctor before taking any medication.

- Avoid Straining: As you mentioned, straining during urination can exacerbate pain. Try to relax and allow urine to flow naturally.

Conclusion
In summary, the symptoms you are experiencing after your endoscopic ureteral stone removal are generally consistent with normal recovery. The pain should gradually diminish over the next few days to weeks. However, if you have concerns about the persistence of pain or any new symptoms, it is essential to follow up with your healthcare provider for further evaluation and management. Your proactive approach to understanding your symptoms and seeking guidance is crucial for a smooth recovery.

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