LBA02-08: Risk factors for increased stent-associated symptoms following ureteroscopy for urinary stones: results from the Urinary Stone Disease Research Network (USDRN) STENTS study

Jonathan Harper, Hongqiu Yang, Naim Maalouf, Jodi Antonelli, Alana Desai, Henry Lai, Peter Reese, Gregory Tasian, Hunter Wessells, Hussein Al-Khalidi, Ziya Kirkali, Charles Scales Jr

Introduction: The USDRN STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) sought to identify risk factors for increased post-ureteroscopic pain, urinary symptoms, and their interference with daily activities in a prospective multicenter observational cohort study.

Methods: Patients aged =12 years undergoing unilateral ureteroscopy with ureteral stent placement for stone treatment were enrolled at 4 U.S. clinical centers. Participants reported symptoms at baseline, on post-operative days (POD) 1, 3, 5, at stent removal, and day 30 post-stent removal using the Brief Pain Inventory short form and PROMIS 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 (LURN SI-10). Multivariable analyses using mixed-effects linear regression models were implemented.

Results: 424 participants (396 adults) were enrolled. Median age (years) was 54 in adults and 15 in adolescents; 46.9% were female. Dominant stone location was ureteral in 56% and renal in 44% of participants.  Mean ureteroscopy time was 57(SD ±30) min. There was a marked increase in pain and urinary symptoms from baseline to POD 1, with a gradual fall on days 3 to 5, returning below baseline 30 days after stent removal. As pain intensity decreased over time, interference remained elevated.  On multivariable regression (Table), older age was associated with less postoperative pain intensity (p=0.004).  Having chronic pain conditions (p < 0.001), prior severe ureteral stent pain (p=0.021), and depression at baseline (p < 0.001) were each associated with higher pain intensity. Neither stone location, ureteral access sheath use, nor stent size were associated with average pain intensity, pain interference, or urinary symptoms.

Conclusions: In this well-characterized, multicenter prospective cohort, interference persisted even as pain intensity decreased over time. Patient factors such as depression, rather than surgical factors, impacted symptom severity. These findings provide a foundation for patient counseling and highlight potential targets for future efforts to mitigate the burden of stent-associated symptoms.

Source of Funding: NIH/NIDDK