Acute postoperative pain after ureteroscopic removal of stone: incidence and risk factors

Sun Tae Ahn, Jae Heon Kim, Jae Young Park, Du Geon Moon, Jae Hyun Bae, Sun Tae Ahn, Jae Heon Kim, Jae Young Park, Du Geon Moon, Jae Hyun Bae

Abstract

Purpose: Ureteroscopic removal of stones (URS) has been widely used to treat ureteral stones because it is comparatively safe, has a high success rate, and enables patients to rapidly return to their daily routines. However, some patients experience pain after URS, but the incidence of acute post-URS pain remains largely unknown. This study aimed to investigate the incidence of acute postoperative pain after URS and the associated risk factors.

Materials and methods: Data for 143 consecutive patients who underwent URS from June 2008 to December 2010 were collected. After excluding 8 patients who developed intraoperative complications, the patients were divided into two groups according to postoperative pain on the first postoperative day. Acute postoperative pain was defined as a pain score greater than 4 on a visual analogue pain scale (normal range, 0 to 10). Various factors were analyzed to identify the risk factors that could predict acute postoperative pain after URS.

Results: The stone-free rate without URS intraoperative complications was 95.5%. A total of 21 (14.6%) patients experienced postoperative pain on the first postoperative day. Young age, psychiatric illness, history of urinary tract infection, use of a stone basket, large stone size, and prolonged operation time were identified as risk factors for acute postoperative pain.

Conclusions: The incidence of acute postoperative pain is not that low and should not be overlooked, because it is associated with postoperative complications that could result in an unscheduled hospital admission or visit. Active pain control should be contemplated after URS in young patients and in those with a history of urinary tract infection, psychiatric illness, large stone size, and prolonged operation time.

Keywords: Pain, postoperative; Ureterolithiasis; Ureteroscopy.

Conflict of interest statement

The authors have nothing to disclose.

References

    1. Goodman TM. Ureteroscopy with pediatric cystoscope in adults. Urology. 1977;9:394.
    1. Lyon ES, Kyker JS, Schoenberg HW. Transurethral ureteroscopy in women: a ready addition to the urological armamentarium. J Urol. 1978;119:35–36.
    1. Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am. 2000;27:623–631.
    1. Wolf JS., Jr Treatment selection and outcomes: ureteral calculi. Urol Clin North Am. 2007;34:421–430.
    1. Peschel R, Janetschek G, Bartsch G. Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective randomized study. J Urol. 1999;162:1909–1912.
    1. Erhard M, Salwen J, Bagley DH. Ureteroscopic removal of mid and proximal ureteral calculi. J Urol. 1996;155:38–42.
    1. Tan HJ, Strope SA, He C, Roberts WW, Faerber GJ, Wolf JS., Jr Immediate unplanned hospital admission after outpatient ureteroscopy for stone disease. J Urol. 2011;185:2181–2185.
    1. Pearle MS, Calhoun EA, Curhan GC Urologic diseases of America Project. Urologic diseases in America project: urolithiasis. J Urol. 2005;173:848–857.
    1. Cheung MC, Lee F, Leung YL, Wong BB, Chu SM, Tam PC. Outpatient ureterscopy: Predictive factors for postoperative events. Urology. 2001;58:914–918.
    1. Bromwich EJ, Lockyer R, Keoghane SR. Day-case rigid and flexible ureteroscopy. Ann R Coll Surg Engl. 2007;89:526–528.
    1. Pérez-Castro Ellendt E, Martinez-Piñero JA. Ureteral and renal endoscopy. A new approach. 1982. Eur Urol. 2006;50:396–399.
    1. Turk TM, Jenkins AD. A comparison of ureteroscopy to in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi. J Urol. 1999;161:45–46.
    1. Anderson KR, Keetch DW, Albala DM, Chandhoke PS, McClennan BL, Clayman RV. Optimal therapy for the distal ureteral stone: extracorporeal shock wave lithotripsy versus ureteroscopy. J Urol. 1994;152:62–65.
    1. Chew BH, Denstedt JD. Ureteroscopy and retrograde ureteral access. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders; 2007. pp. 1508–1525.
    1. Kim JY, Shim BS. Ureteroscopic stone removal: efficacy, safety and skilled experience of the surgeon. Korean J Urol. 2001;42:795–799.
    1. Goodman TM. Ureteroscopy with rigid instruments in the management of distal ureteral disease. J Urol. 1984;132:250–253.
    1. Lee MS, Kim JW. The management of ureteral calculi with the ureteroscopy: failure cases and complications. Korean J Urol. 1988;29:51–55.
    1. Green DF, Lytton B. Early experience with direct vision electrohydraulic lithotripsy of ureteral calculi. J Urol. 1985;133:767–770.
    1. Yang JJ, Park HY, Lee TY. Cause of failure and complication of ureteroscopic removal of stone. Korean J Urol. 1996;37:894–897.
    1. Huffman JL. Ureteroscopic injuries to the upper urinary tract. Urol Clin North Am. 1989;16:249–254.
    1. Gerber GS, Brendler CB. Evaluation of the urologic patient: history, physical examination, and urinalysis. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders; 2007. pp. 81–110.
    1. el-Faqih SR, Shamsuddin AB, Chakrabarti A, Atassi R, Kardar AH, Osman MK, et al. Polyurethane internal ureteral stents in treatment of stone patients: morbidity related to indwelling times. J Urol. 1991;146:1487–1491.
    1. Hosking DH, McColm SE, Smith WE. Is stenting following ureteroscopy for removal of distal ureteral calculi necessary? J Urol. 1999;161:48–50.
    1. Hollenbeck BK, Schuster TG, Faeber GJ, Wolf JS., Jr Routine placement of ureteral stents is unnecessary after ureteroscopy for urinary calculi. Urology. 2001;57:639–643.
    1. Papaioannou M, Skapinakis P, Damigos D, Mavreas V, Broumas G, Palgimesi A. The role of catastrophizing in the prediction of postoperative pain. Pain Med. 2009;10:1452–1459.
    1. Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111:657–677.
    1. Gloth FM., 3rd Principles of perioperative pain management in older adults. Clin Geriatr Med. 2001;17:553–573.
    1. Al Absi M, Rokke PD. Can anxiety help us tolerate pain? Pain. 1991;46:43–51.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться