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JU INSIGHT Evaluation of Pain Before and After Removal of Nonobstructing Renal Calculi: A CoRE Initiative

By: Naeem Bhojani, MD, University of Montreal, Quebec, Canada; Daniel A. Wollin, MD, MS, Brigham and Women’s Hospital, Boston, Massachusetts; Marawan M. El Tayeb, MD, Baylor Scott and White Health, Temple, Texas; Kymora B. Scotland, MD, PhD, University of California, Los Angeles; John Knoedler, MD, Pennsylvania State University Medical Center, Hershey; Karen L. Stern, MD, Mayo Clinic, Phoenix, Arizona; David-Dan Nguyen, MDCM, MPH, University of Toronto, Ontario, Canada; Marcelino Rivera, MD, Indiana University, Indianapolis; Michael S. Borofsky, MD, University of Minnesota, Minneapolis; Noah Canvasser, MD, UC Davis Medical Center, Sacramento, California; Seth K. Bechis, MD, University of California, San Diego; Ryan S. Hsi, MD, Vanderbilt University Medical Center, Nashville, Tennessee For the Collaborative for Research in Endourology (CoRE) | Posted on: 18 Mar 2024

Bhojani N, Wollin DA, El Tayeb MM, et al. Prospective multicenter evaluation of pain before and after removal of nonobstructing renal calculi: a CoRE initiative. J Urol. 2024;211(3):436-444.

Study Need and Importance

Flank pain associated with stone disease is typically caused by a stone that obstructs urine flow. Controversy exists regarding whether nonobstructing kidney stones may still cause pain. This is an important study as patients with nonobstructing stones are often not offered treatment and are forced to suffer through their pain. In light of this, we performed a multicenter, observational trial to evaluate whether treatment of small nonobstructing calyceal stones improves pain and health-related quality of life.

What We Found

A total of 43 patients with nonobstructing kidney stones and associated flank pain were recruited. All stones were removed. Preoperatively, Brief Pain Inventory scores for mean pain and worst pain were 5.5 and 7.2, respectively, which decreased to 1.8 and 2.8, respectively, at 12 weeks postoperatively (Figure 1). Wisconsin Stone Quality of Life mean score increased from 70.4 to 115.3 at 12 weeks postoperatively (Figure 2). A total of 86% and 69% of patients had at least a 20% and 50% reduction in their mean pain scores, respectively.


Figure 1. Decrease in mean Brief Pain Inventory (BPI) pain levels after ureteroscopy for patients suffering from nonobstructive renal calculi.


Figure 2. Increase in mean Wisconsin Quality of Life (WIQOL) scores after ureteroscopy for patients suffering from nonobstructive renal calculi. QOL indicates quality of life.


Although this was a prospective study, it was a single-arm study; there was no control or sham arm. Patients were only followed out to 12 weeks. Beyond this period, it is unknown if pain and quality of life would return to preintervention levels.

Interpretation for Patient Care

This study determined that patients can benefit significantly from the removal of calyceal nonobstructing kidney stones for at least 12 weeks with a reduction in pain and an increase in quality of life. Therefore, surgical removal of these stones in this patient population should be offered as a treatment option.