JU INSIGHT Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones

By: Jonathan D. Harper, MD, University of Washington, Seattle; Alana C. Desai, MD, Washington University in St Louis, Missouri; Naim M. Maalouf, MD, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas; Hongqiu Yang, PhD, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Jodi A. Antonelli, MD, Duke Surgical Center for Outcomes Research & Equity in Surgery, Duke University School of Medicine, Durham, North Carolina; Gregory E. Tasian, MD, Children’s Hospital of Philadelphia, Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; H. Henry Lai, MD, Washington University in St Louis, Missouri; Peter P. Reese, MD, University of Pennsylvania, Philadelphia; Michele Curatolo, MD, University of Washington, Seattle; Ziya Kirkali, MD, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; Hussein R. Al-Khalidi, PhD, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Hunter Wessells, MD, University of Washington, Seattle; Charles D. Scales Jr, MD, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, Duke Surgical Center for Outcomes Research & Equity in Surgery, Duke University School of Medicine, Durham, North Carolina, For the Urinary Stone Disease Research Network | Posted on: 18 May 2023

Harper JD, Desai AC, Maalouf NM, et al. Risk factors for increased stent-associated symptoms following ureteroscopy for urinary stones: results from STENTS. J Urol. 2023;209(5):971-980.

Study Need and Importance

Ureteral stents are an integral element of the treatment of urinary stones but are often associated with bothersome pain and urinary symptoms. The inability to identify patients at highest risk for increased stent-associated symptoms, and what aspects of care contribute to these symptoms, were key reasons for the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS). We conducted a prospective, observational cohort study of individuals undergoing ureteroscopy (URS) and stenting for treatment of stones. Our specific objectives were to examine the time course of these symptoms and identify factors associated with increased stent-associated symptoms.

What We Found

Participants experienced a marked increase in stent-associated symptoms on postoperative day (POD) 1. While pain intensity decreased ∼50% from POD 1 to POD 5, interference due to pain remained persistently elevated. Older age was associated with lower pain intensity. Having chronic pain conditions, prior severe stent pain, and depressive symptoms at baseline were each associated with higher pain intensity (see Figure). Sex, stone location, ureteral access sheath use, and stent characteristics were not associated with stent-associated symptoms.

Figure. Risk factors for increased stent-associated pain intensity. Measured using Patient-Reported Outcome Measurement Information System. Multivariable model. BMI indicates body mass index; CI, confidence interval.

Limitations

The study was not designed to compare the independent contributions of the stent and URS. Ascertainment of prior stent experience may be subject to recall bias. Ureteroscopic interventions were performed at academic medical centers, and despite the large, prospectively characterized population, these results may not be generalizable to other settings.

Interpretation for Patient Care

Although pain and symptom intensity after URS and stent placement decrease early in the postoperative period, interference of daily activities persists. Patient factors such as age and depression impacted symptom severity, rather than surgical or stone factors. These findings provide a foundation for patient counseling, set the stage for prediction modeling to identify those at risk for the most severe pain, and highlight potential targets for future efforts to mitigate the burden of stent-associated symptoms and improve the overall patient experience.