What is included in postsurgical care and follow-up of patients with nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

After surgical treatment of urinary tract calculi, the major issues include infection, ureteral obstruction, and hemorrhage. The postoperative course of minimally invasive stone-removal modalities is generally characterized by short-lived discomfort easily managed with oral medications. Continued or severe pain should prompt evaluation for complications. Repeat urine cultures and imaging studies should be performed to assess for ureteral obstruction and perforation, and the degree of circulating blood volume should be evaluated for ongoing hemorrhage.

The importance of office follow-up and examination should be stressed with patients. Though EAU and AUA guidelines have not provided a consensus statement regarding timing or modality specifics for follow-up imaging, it is recommended that some imaging modality be completed in the post-operative setting. Undiagnosed residual stone fragments and silent hydronephrosis pose potential threats in post-operative settings. The most recent 2018 EAU guideline suggests follow up imaging around one month. [1]

Once postoperative complications have been excluded and the patient is clinically healthy, standard radiographic follow-up care includes abdominal radiography or ultrasound every 6-12 months. Imaging is often performed in conjunction with metabolic chemoprophylaxis. Above and beyond this, additional imaging is often unnecessary in a patient with a previous radiopaque stone who has no further symptoms. Imaging that includes assessment of renal drainage (eg, IVP, ultrasonography, CT scanning) is usually indicated in the following cases:

  • Stones with unusual characteristics

  • Difficult or complicated procedures

  • Patients with unusual symptoms


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