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Blood in Urine After Kidney Stone Surgery: What Is Normal?

Blood in Urine After Kidney Stone Surgery: What Is Normal?

📖 7 min read Written/reviewed by Dr. Alhad Naragude, MBBS, MS, DrNB Urology Last updated: June 27, 2026

Blood in urine after kidney stone surgery is common, especially in the first few days. Your urine may look pink, light red, tea-coloured or cloudy after URSL, RIRS, PCNL, ESWL or DJ stent placement. Mild bleeding that gradually reduces is usually part of healing. But heavy bright-red urine, large clots, fever, chills, severe kidney pain, dizziness, vomiting or inability to pass urine are warning signs. These symptoms need urgent advice from your urologist or emergency care.

Why does blood in urine happen after kidney stone surgery?

Kidney stone procedures can irritate the inner lining of the urinary tract. During ureteroscopy, URSL or RIRS, a thin telescope is passed through the urinary passage, bladder and ureter to reach the stone. The stone may be broken with laser, removed with a basket or left as tiny fragments to pass naturally. A temporary ureteric stent may also be placed to help urine drain while the ureter heals.

After PCNL, the stone is removed through a small puncture made directly into the kidney. Because the kidney has a rich blood supply, blood in urine is often more noticeable after PCNL than after URSL or RIRS. PCNL recovery may take a few weeks, and blood clots can sometimes block urine flow.

Blood in urine after kidney stone surgery: what is usually normal?

Mild bleeding is usually acceptable when:

  • Urine is light pink, reddish or tea-coloured.
  • Bleeding is reducing day by day.
  • Blood increases slightly after walking, stairs or travel, then settles with rest.
  • You have mild burning while passing urine.
  • Small stone dust or tiny fragments pass in urine.
  • You have a DJ stent and blood comes and goes.
  • There is no fever, severe pain, dizziness or difficulty passing urine.

A ureteric stent can cause urinary frequency, urgency, bladder discomfort, burning, kidney-side pain and blood in urine. These symptoms may mimic a urine infection, but they are often due to stent irritation while the stent is inside.

Quick decision guide: observe, call or go urgently

What you notice What it may mean What to do
Light pink urine that is improving Common healing pattern Drink fluids if allowed, rest and observe
Blood increases after walking but settles Common with DJ stent irritation Reduce activity and monitor
Burning without fever Stent or urinary tract irritation Continue prescribed medicines and follow up
Bright-red urine that keeps increasing More than expected bleeding Call your urologist urgently
Large blood clots Possible clot-related blockage risk Seek urgent medical care
Unable to pass urine Possible clot retention or blockage Go to emergency care
Fever, chills or severe weakness Possible infection or sepsis risk Go to emergency care
Severe kidney-side pain with vomiting Possible blockage, clot or stone fragment Seek urgent medical care
Soaked PCNL dressing or active wound bleeding Possible wound or tract bleeding Contact your surgeon urgently

How long can blood in urine last?

The duration depends on the procedure, stone size, infection, use of blood thinners and whether a DJ stent is present.

Procedure Usual bleeding pattern
ESWL Mild blood may occur as shock waves break the stone and fragments pass.
URSL Mild blood and burning often improve over a few days.
RIRS Mild bleeding usually settles over days, but may come and go if a stent is present.
PCNL Bleeding is often more noticeable initially because the kidney is punctured. Recovery can take 2–4 weeks.
DJ stent Blood may appear intermittently until stent removal, especially after activity.

NIDDK lists shock wave lithotripsy, ureteroscopy and PCNL as common treatments used to break or remove kidney stones. A stent may be placed in some patients to help urine flow or allow fragments to pass.

Warning signs: when blood in urine is not normal

Contact your urologist urgently or go to emergency care if you have:

  • Bright-red urine that is increasing.
  • Large blood clots.
  • Inability to pass urine.
  • Fever or chills.
  • Severe kidney-side pain.
  • Severe burning with fever.
  • Dizziness, fainting or marked weakness.
  • Reduced urine output.
  • Persistent vomiting.
  • Blood leaking from a PCNL puncture site.
  • Dressing getting soaked after PCNL.
  • Bleeding that worsens after restarting blood thinners.

BAUS advises urgent contact after ureteroscopy if a patient develops fever, kidney-area pain, severe pain while passing urine, inability to pass urine or worsening bleeding.

What you can do at home

Drink adequate fluids unless your doctor has restricted fluids because of kidney, heart or other medical conditions. Fluids may help dilute the urine and flush small clots, stone dust or tiny fragments.

Rest if urine becomes darker after activity. Mild worsening after walking or travel can happen, especially with a DJ stent. It should improve with rest.

Avoid heavy lifting, intense exercise, long bike rides and straining during stools until your urologist clears you. Take only the medicines prescribed at discharge.

Do not self-start antibiotics just because urine is red. Blood in urine alone does not always mean infection. Fever, chills, foul-smelling urine, worsening burning or increasing pain need urine testing and medical review.

Be careful with blood thinners

Tell your urologist if you take aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, dabigatran or any other blood thinner.

Do not restart blood thinners on your own after surgery. Restarting too early may increase bleeding, while stopping for too long may be risky for heart, brain or vascular conditions. Your urologist and physician or cardiologist should guide the timing.

Blood in urine with a DJ stent

A DJ stent can rub against the bladder and kidney side. This may cause blood in urine, burning, frequent urination, urgency, pain at the end of urination and kidney-side pain while passing urine. These symptoms can increase after walking, stairs or travel.

This is usually manageable, but fever, severe pain, large clots, inability to pass urine or suspected stent displacement needs urgent advice. Stents should also be removed or changed on time, because long-retained stents can become encrusted and difficult to remove.

Blood in urine after PCNL

After PCNL, mild blood in urine is expected because the kidney has been entered through a small tract. The urine should gradually become lighter.

Urgent review is needed if there is persistent bright-red urine, large clots, falling urine output, dizziness, increasing flank pain, bleeding from the puncture site, fever or chills. Rarely, significant bleeding after PCNL may need admission, blood transfusion or a radiology procedure to block the bleeding vessel.

Will blood in urine affect stone clearance?

Mild blood usually does not mean the surgery has failed. It often reflects healing, stent irritation or passage of small fragments.

But blood with severe pain, fever, vomiting or reduced urine output may suggest blockage, infection, clot retention or residual fragments. In such cases, your urologist may advise urine tests, blood tests and imaging.

Follow-up after bleeding settles

Even if bleeding stops, follow-up is important after kidney stone surgery. Your urologist may advise:

  • Urine routine.
  • Urine culture if infection is suspected.
  • CBC if bleeding was significant.
  • Serum creatinine.
  • USG KUB.
  • X-ray KUB if the stone is visible on X-ray.
  • CT KUB in selected cases.
  • DJ stent removal on the planned date.
  • Stone analysis.
  • 24-hour urine test for recurrent stones.
  • Diet and prevention plan.

Consultation checklist: what to bring

Bring these to your visit:

  • Discharge summary.
  • Operation notes, if available.
  • Type of surgery: URSL, RIRS, PCNL or ESWL.
  • DJ stent card or stent removal date.
  • USG KUB, X-ray KUB or CT KUB reports.
  • Urine routine and urine culture reports.
  • CBC and creatinine reports.
  • Current medicines.
  • Blood thinner details, if any.
  • Photos of urine colour if bleeding comes and goes.
  • Fever chart, if present.

FAQs

Is blood in urine after kidney stone surgery normal?

Yes. Mild blood in urine after kidney stone surgery is common for a few days. It should gradually reduce. Heavy bleeding, clots, fever, severe pain or inability to pass urine need urgent care.

Can a DJ stent cause blood in urine?

Yes. A DJ stent can cause blood in urine, burning, frequency, urgency and kidney-side discomfort. Symptoms may come and go until the stent is removed.

Why does blood increase after walking?

Walking, stairs or travel can irritate the healing urinary tract or DJ stent. Mild increase that settles with rest is common. Heavy bleeding or clots should be checked urgently.

Is blood after PCNL more serious?

Not always. Mild blood after PCNL is expected because the kidney is entered through a small puncture. But heavy bleeding, clots, dizziness, fever or worsening pain after PCNL needs urgent review.

Should I drink more water if urine is red?

Adequate fluids can help many patients, but follow your doctor’s advice if you have kidney disease, heart disease or fluid restriction.

Can blood in urine mean infection?

Blood alone does not always mean infection. But blood with fever, chills, foul-smelling urine, severe burning or worsening pain may suggest infection and needs medical evaluation.

When should I go to the hospital immediately?

Go urgently if you cannot pass urine, have large clots, fever, chills, severe pain, dizziness, vomiting or worsening bright-red bleeding.

Related reading

References

Note: This information is for educational purposes only and is not a substitute for medical advice. Please consult your doctor for any symptoms.