Presented by: Jonathan Harper MD
University of Washington

Introduction

Previously published data from STENTS reported the time course of stent-associated symptoms (SAS) and factors associated with increased pain. However, there remains a paucity of information regarding the location and site-specific intensity of stent-associated pain. We hypothesized that differences in these factors may exist between sexes due to dissimilar genitourinary anatomy and voiding patterns, and that differences may exist based on stone location. The objective of this analysis was to characterize pain location and intensity after URS and ureteral stent, and to describe differences between sexes and primary stone location.

Materials

STENTS participants completed questionnaires at baseline and on postoperative day (POD) 1, 3, 5, 7-9, and 30 days after stent removal. Pain distribution and intensity were characterized with the Brief Pain Inventory, in which participants localized specific sites of pain using a detailed body map, indicating the site of most intense pain at each time point. These findings were stratified by sex and primary stone location.

Results

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424 participants enrolled in STENTS at five US health systems; 47% were female and mean age was 49 years (SD 17). The dominant stone location was 50% renal and 50% ureteral. The most frequent sites of pain were the back followed by abdomen and pubic region, all ipsilateral to the stone. Of these 3 sites, the site of most intense pain on POD 1 was equally reported in the ipsilateral back (38%) and abdomen (38%) followed by pubic region (24%). On POD 5, 42% reported pain in the ipsilateral back as most intense, followed by abdomen (34%) and pubic region (24%).

Men were more likely to report ipsilateral back as the most intense pain site on POD 1 (p = 0.003) and POD5 (p = 0.007), independent of dominant stone location. Women more often reported pain in the abdominal region on POD1 (p = 0.008) and in the pubic region on POD3 (p = 0.003). Compared to those with ureteral stones, those with a dominant renal stone were more likely to: 1) have ipsilateral back pain on POD 1-5 (p < 0.05) and 2) report a higher pain intensity score at various sites and timepoints.

Conclusion

Pain distribution after URS with ureteral stent, including location of most severe pain, changed over time, and differed between sexes and by stone location.  These results facilitate counseling and may contribute to a better understanding of the patient experience and identification of patient pain phenotypes.

Funding

US National Institutes of Health/NIDDK

Lead Authors

Andrew Rabley,
University of Washington

Co-Authors

Naim Maalouf,
University of Texas Southwestern Medical Center

Hongqiu Yang,
Duke Clinical Research Institute

Alana Desai,
University of Washington

Peter Reese,
University of Pennsylvania

Gregory Tasian,
Children's Hospital of Philadelphia

Hunter Wessells,
University of Washington

Hussein Al-Khalidi,
Duke Clinical Research Institute

Henry Lai,
Washington University in St. Louis

Michele Curatolo,
University of Washington

Jodi Antonelli,
Duke Urology

Matthew Sorensen,
University of Washington

Rob Sweet,
University of Washington

Ziya Kirkali,
National Institute of Diabetes and Digestive and Kidney Diseases

Charles Scales,
Duke Clinical Research Institute, Duke Urology