Development of Prediction Models for Severe Pain and Urinary Symptoms after Ureteroscopy with Ureteral Stent Placement: Results from the STENTS Study and Initial Validation of Pain Interference

Purpose:We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement.Materials and Methods:The development cohort included 424 adults and adolescents enrolled in the multicenter STENTS prospective cohort study who underwent ureteroscopy with stent placement for urinary stones. The validation cohort was an independent prospective cohort of 115 adults. The outcomes were severe pain intensity and pain interference, measured by PROMIS, and severe urinary symptoms, measured by the Ureteral Stent Symptom Questionnaire. The top quartile of symptoms on postoperative days 1 and 3 were defined as severe. Generalized estimating equation models were used to predict severe symptoms on postoperative days 1, 3, 5, and 7-9 in the development cohort and severe pain interference on days 1 and 7 in the validation cohort.Results:Female sex, younger age, higher body mass index, baseline pain interference and number of chronic pain conditions, renal stone location, and history of anxiety predicted severe pain. In the development cohort, the C-statistics were 0.83 (95% CI 0.80-0.85) for severe pain interference and 0.82 (95% CI 0.79-0.84) for severe pain intensity. A model in which baseline urinary symptoms replaced pain interference had excellent discrimination for severe urinary symptoms (C-statistic 0.83; 95% CI 0.81-0.85). In the validation cohort, the C-statistic was 0.7 for severe pain interference (95% CI 0.54-0.78).Conclusions:Preoperative characteristics accurately predicted severe pain and urinary symptoms after ureteroscopy with stent placement. Upon further validation, these models could guide clinical decisions to improve surgical outcomes.