Postoperative urology, gynecology, and other abdominal surgical patients often come to the intensive care unit (ICU) with externally draining ureteral stents; some of these patients may have undergone reimplantation of the ureters during urinary diversion. Invariably, in the middle of the night the likely bloody urine output will decrease and the house officer may be presented with the opportunity or request to flush these stents. However, before doing so there are several important factors to consider.

The prime consideration is whether there exists any other reason the patient may have decreased urine output through the stents. The astute clinician will evaluate the postoperative fluid resuscitation, cardiac status, and infectious status of the patient. An exam should be performed to make sure the patient does not have any other catheters in place draining the bladder or kidneys. An assessment must include the amount of fluid draining around the stents in a capillary-type manner. Immediately postoperatively, ureteral edema may cause ureteral obstruction, and therefore the majority of urine output typically comes from the stents in the early postoperative period. As edema decreases, the ureters may drain urine around the stents, decreasing the output from the stents but maintaining good overall urine output.