TY - JOUR
T1 - Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones
T2 - Results from STENTS
AU - Urinary Stone Disease Research Network
AU - Harper, Jonathan D.
AU - Desai, Alana C.
AU - Maalouf, Naim M.
AU - Yang, Hongqiu
AU - Antonelli, Jodi A.
AU - Tasian, Gregory E.
AU - Lai, H. Henry
AU - Reese, Peter P.
AU - Curatolo, Michele
AU - Kirkali, Ziya
AU - Al-Khalidi, Hussein R.
AU - Wessells, Hunter
AU - Scales, Charles D.
AU - Reese, Peter P.
AU - Tasian, Gregory E.
AU - Ziemba, Justin
AU - Funsten, Emily
AU - Mussell, Adam
AU - McCune, Rebecca
AU - Shah, Salima
AU - Jain, Arushi
AU - Selman-Fermin, Antoine
AU - Maalouf, Naim M.
AU - Antonelli, Jodi A.
AU - Johnson, Brett A.
AU - Pearle, Margaret S.
AU - Baker, Linda A.
AU - Piskator, Brooke
AU - Obiaro, Joyce
AU - Rangel, Cynthia
AU - Hill, Martinez
AU - Harper, Jonathan D.
AU - Wessells, Hunter
AU - Curatolo, Michele
AU - Edwards, Todd
AU - Sorensen, Mathew
AU - Sweet, Robert
AU - Baxter, Tristan
AU - Covert, Holly
AU - Ayala, Elsa
AU - Flint, Lisa
AU - Cho, Grace
AU - Marshall, Grace
AU - Desai, Alana
AU - Lai, H. Henry
AU - Du, Kefu
AU - Mueller, Susan
AU - Black, Linda
AU - Klim, Aleksandra
AU - Scales, Charles D.
AU - Al-Khalidi, Hussein R.
AU - Corneli, Amy
AU - Reeve, Bryce
AU - Weinfurt, Kevin
AU - Yang, Hongqiu
AU - Andersen, Davy
AU - Johnson, Laura
AU - Dodd, Andrew
AU - Thompson, Omar
AU - Dombeck, Carrie
AU - McKenna, Kevin
AU - Swezey, Teri
AU - Mullins, Christopher
N1 - Funding Information:
Support: This research was supported by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, as follows: U01DK110961 (UPenn/CHOP – Reese, Tasian), U01KD110986 (Washington Univ. St Louis – Desai, Lai), U01DK110994 (UT Southwestern – Maalouf), U01DK110954 (University of Washington – Harper, Wessells), and U01DK110988 (Duke University – Scales, Al-Khalidi).
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - 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.
AB - 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.
KW - pain, urinary calculi
KW - patient outcome assessment
KW - stents
KW - ureteroscopy
UR - http://www.scopus.com/inward/record.url?scp=85152165739&partnerID=8YFLogxK
U2 - 10.1097/JU.0000000000003183
DO - 10.1097/JU.0000000000003183
M3 - Article
C2 - 36648152
AN - SCOPUS:85152165739
SN - 0022-5347
VL - 209
SP - 971
EP - 980
JO - Journal of Urology
JF - Journal of Urology
IS - 5
ER -