Nephrolithotripsy: instructions before and after surgery

General and important instructions before surgery

Before surgery:

- When you are admitted to the hospital, bring all the tests performed for the surgery.
- Fasting before surgery must last at least 8 hours, including water.
- Allergies to medications, latex, foods or anything else must be reported to the medical and nursing team at admission.
- Antihypertensive medications (blood pressure medicines) should be taken even on the day of surgery, with the smallest amount of water needed to swallow them.
- Some medications must be stopped before surgery:
- Oral hypoglycemic agents (diabetes medicines) must be stopped the day before surgery
- Antiplatelet agents such as acetylsalicylic acid (AAS®, Somalgin®, etc.) and clopidogrel (Plavix®, etc.) must be stopped at least 7 days before surgery if the patient takes only one of these medications. If both are used, they must be stopped 10 days before the procedure.
- Patients taking anticoagulants such as warfarin (Marevan®) or rivaroxaban (Xarelto®) must stop the medication 5 and 3 days before, respectively. During this period, some patients will need to use enoxaparin sodium or unfractionated heparin until the day before surgery.

Instructions after surgery

After surgery:

- After returning from surgery to the room, once the patient is fully awake, they may eat the diet prescribed by the medical team. Food should be introduced according to the patient's tolerance. At this point, it is possible to get out of bed and walk around the room with the help of a family member or a member of the nursing team.
- In general, a bladder catheter is not needed after the procedure, but in certain situations it may be necessary.
- In most cases, patients undergoing endoscopic procedures to remove stones from the kidney or ureter (ureterorenolithotripsy) need to keep a double-J stent, which stays in place for about 2 to 4 weeks depending on their doctor's assessment.
- The hospital stay is usually 1 day.

After hospital discharge:

- Symptoms such as dysuria (burning or pain when urinating) and urgency (a strong urge to urinate) are common in the first days after ureterorenolithotripsy and double-J stent placement and tend to decrease progressively.
- Small amounts of blood in the urine may occur in the first days.

Diet:

- There are no specific dietary restrictions; the patient should eat a healthy diet.
- Fluids (water, tea and natural juices) can be consumed freely.

Physical activity:

- During the first 2 weeks after surgery, the patient should keep relative rest, avoiding strenuous work, lifting heavy objects and any kind of intense physical exercise. However, during this period it is important for the patient to move around carefully, and careful daily walks are allowed.
- After 1 week, the patient may do gentle activities such as slightly longer walks. Work that does not require physical effort may be resumed if the patient wishes.
- The patient is usually cleared to drive after 10 to 14 days following surgery.
- After discharge, the patient may go up and down stairs carefully.

Medications:

- At discharge, you will receive instructions on the medications to take at home. In general, painkillers are prescribed for mild pain. Antibiotics are used only prophylactically before surgery and are not prescribed for home use except in selected cases the medical team deems necessary.

Important:

In case of severe pain that does not improve with the prescribed painkillers, significant bleeding in the urine, fever, shortness of breath associated with pain when breathing, malaise associated with a drop in blood pressure, or any other complication or concern, go directly to the emergency department of the hospital where you had your surgery.

This information is intended as general guidance for patients. It does not replace the in-person guidance given by your attending physician, which must be individualized according to the characteristics of the patient, the disease and the planned operation.