Quality of life impact and recovery after ureteroscopy and stent insertion: insights from daily surveys in STENTS

Jonathan D Harper, Alana C Desai, Jodi A Antonelli, Gregory E Tasian, Justin B Ziemba, Hussein R Al-Khalidi, H Henry Lai, Naim M Maalouf, Peter P Reese, Hunter B Wessells, Ziya Kirkali, Charles D Scales Jr, NIDDK Urinary Stone Disease Research Network (USDRN), Jonathan D Harper, Alana C Desai, Jodi A Antonelli, Gregory E Tasian, Justin B Ziemba, Hussein R Al-Khalidi, H Henry Lai, Naim M Maalouf, Peter P Reese, Hunter B Wessells, Ziya Kirkali, Charles D Scales Jr, NIDDK Urinary Stone Disease Research Network (USDRN)

Abstract

Background: Our objective was to describe day-to-day evolution and variations in patient-reported stent-associated symptoms (SAS) in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS), a prospective multicenter observational cohort study, using multiple instruments with conceptual overlap in various domains.

Methods: In a nested cohort of the STENTS study, the initial 40 participants having unilateral ureteroscopy (URS) and stent placement underwent daily assessment of self-reported measures using the Brief Pain Inventory short form, Patient-Reported Outcome Measurement Information System measures for pain severity and pain interference, the Urinary Score of the Ureteral Stent Symptom Questionnaire, and Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index. Pain intensity, pain interference, urinary symptoms, and bother were obtained preoperatively, daily until stent removal, and at postoperative day (POD) 30.

Results: The median age was 44 years (IQR 29,58), and 53% were female. The size of the dominant stone was 7.5 mm (IQR 5,11), and 50% were located in the kidney. There was consistency among instruments assessing similar concepts. Pain intensity and urinary symptoms increased from baseline to POD 1 with apparent peaks in the first 2 days, remained elevated with stent in situ, and varied widely among individuals. Interference due to pain, and bother due to urinary symptoms, likewise demonstrated high individual variability.

Conclusions: This first study investigating daily SAS allows for a more in-depth look at the lived experience after URS and the impact on quality of life. Different instruments measuring pain intensity, pain interference, and urinary symptoms produced consistent assessments of patients' experiences. The overall daily stability of pain and urinary symptoms after URS was also marked by high patient-level variation, suggesting an opportunity to identify characteristics associated with severe SAS after URS.

Keywords: Stent-associated symptoms; Ureteral stent; Ureteroscopy; Urinary stone disease.

Conflict of interest statement

Dr. Antonelli has relationships with the following entities: Boston Scientific Corp, Cook Medical (Advisory Board). Dr. Tasian has relationships with the following entities: Dicerna (advisory board, scientific study), Alnylam (advisory board), Novome (advisory board), and Allena Pharmaceuticals (consultant). No other authors reported disclosures relevant to this study.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Daily stent-associated symptoms in each domain measured with various instruments displayed in box and whisker plots. The range (whiskers) is shown for each timepoint while the box represents the interquartile range. Circles depict mean values and the median values are connected by a line: A BPI pain severity, B PROMIS pain intensity, C BPI pain interference, D PROMIS pain interference, E Urinary score of USSQ (USSQ-U), F LURN SI-10 urinary symptoms

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