We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement.
The development cohort included 424 adults and adolescents enrolled in the multicenter STENTS prospective cohort study who underwent ureteroscopy with stent placement for urinary stones. The validation cohort was an independent prospective cohort of 115 adults. The outcomes were severe pain intensity and pain interference, measured by PROMIS, and severe urinary symptoms, measured by the Ureteral Stent Symptom Questionnaire. The top quartile of symptoms on postoperative days 1 and 3 were defined as severe. Generalized estimating equation models were used to predict severe symptoms on postoperative days 1, 3, 5, and 7-9 in the development cohort and severe pain interference on days 1 and 7 in the validation cohort.
Female sex, younger age, higher body mass index, baseline pain interference and number of chronic pain conditions, renal stone location, and history of anxiety predicted severe pain. In the development cohort, the C-statistics were 0.83 (95% CI 0.80-0.85) for severe pain interference and 0.82 (95% CI 0.79-0.84) for severe pain intensity. A model in which baseline urinary symptoms replaced pain interference had excellent discrimination for severe urinary symptoms (C-statistic 0.83; 95% CI 0.81-0.85). In the validation cohort, the C-statistic was 0.7 for severe pain interference (95% CI 0.54-0.78).
Preoperative characteristics accurately predicted severe pain and urinary symptoms after ureteroscopy with stent placement. Upon further validation, these models could guide clinical decisions to improve surgical outcomes.
The Journal of urology. 2024 Dec 09 [Epub ahead of print]
Gregory E Tasian, Jonathan D Harper, Hussein R Al-Khalidi, Hongqiu Yang, Naim M Maalouf, Michele Curatolo, H Henry Lai, Alana Desai, Jodi A Antonelli, Jing Huang, Justin B Ziemba, Hunter Wessells, Ziya Kirkali, Charles D Scales, Peter P Reese
Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Department of Urology, University of Washington, Seattle, Washington., Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina., Department of Internal Medicine and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas., Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington., Department of Surgery (Urology), Washington University in St. Louis, St. Louis, Missouri., Department of Urology, Duke University School of Medicine, Durham, North Carolina., Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania., Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.