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Observational Study
. 2023 May;209(5):971-980.
doi: 10.1097/JU.0000000000003183. Epub 2023 Jan 17.

Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTS

Jonathan D Harper  1 , Alana C Desai  2 , Naim M Maalouf  3 , Hongqiu Yang  4 , Jodi A Antonelli  5 , Gregory E Tasian  6   7 , H Henry Lai  2   8 , Peter P Reese  9 , Michele Curatolo  10 , Ziya Kirkali  11 , Hussein R Al-Khalidi  4   12 , Hunter Wessells  1 , Charles D Scales Jr  4   5   13
Affiliations
Observational Study

Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTS

Jonathan D Harper et al. J Urol. 2023 May.

Abstract

Purpose: The STudy to Enhance uNderstanding of sTent-associated Symptoms sought to identify risk factors for pain and urinary symptoms, as well as how these symptoms interfere with daily activities after ureteroscopy for stone treatment.

Materials and methods: This prospective observational cohort study enrolled patients aged ≥12 years undergoing ureteroscopy with ureteral stent for stone treatment at 4 clinical centers. Participants reported symptoms at baseline; on postoperative days 1, 3, 5; at stent removal; and day 30 post-stent removal. Outcomes of pain intensity, pain interference, urinary symptoms, and bother were captured with multiple instruments. Multivariable analyses using mixed-effects linear regression models were identified characteristics associated with increased stent-associated symptoms.

Results: A total of 424 participants were enrolled. Mean age was 49 years (SD 17); 47% were female. Participants experienced a marked increase in stent-associated symptoms on postoperative day 1. While pain intensity decreased ∼50% from postoperative day 1 to postoperative day 5, interference due to pain remained persistently elevated. In multivariable analysis, older age was associated with lower pain intensity (P = .004). Having chronic pain conditions (P < .001), prior severe stent pain (P = .021), and depressive symptoms at baseline (P < .001) were each associated with higher pain intensity. Neither sex, stone location, ureteral access sheath use, nor stent characteristics were drivers of stent-associated symptoms.

Conclusions: In this multicenter cohort, interference persisted even as pain intensity decreased. Patient factors (eg, age, depression) rather than surgical factors were associated with symptom intensity. These findings provide a foundation for patient-centered care and highlight potential targets for efforts to mitigate the burden of stent-associated symptoms.

Keywords: pain, urinary calculi; patient outcome assessment; stents; ureteroscopy.

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Figures

Figure 1:
Figure 1:
SAS change over time. A, Pain intensity (PROMIS); B, pain interference (PROMIS); C, urinary symptoms (LURN SI-10); D, urinary bother (LURN SI-10). Mean point estimate and confidence intervals displayed with p values listed for each day. Red dashed line denotes zero change from baseline.
Figure 2:
Figure 2:
Risk factors for increased stent-associated pain intensity (A) and pain interference (B). Measured using PROMIS. Multivariable model.
Figure 3:
Figure 3:
Risk factors for increased stent-associated urinary symptoms (A) and urinary bother (B). Measured using LURN SI-10. Multivariable model.
See this image and copyright information in PMC

References

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