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,
NIDDK Urinary Stone Disease Research Network (USDRN)
Affiliations
Jonathan D. Harper
Department of Urology, University of Washington School of Medicine
Alana C. Desai
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine
Jodi A. Antonelli
Department of Urology, University of Texas Southwestern Medical Center
Gregory E. Tasian
Division of Pediatric Urology, Department of Surgery, The Children’s Hospital of Philadelphia
Justin B. Ziemba
Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania
Hussein R. Al-Khalidi
Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine
H. Henry Lai
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine
Naim M. Maalouf
Department of Internal Medicine, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center
Peter P. Reese
Renal-Electrolyte and Hypertension Division, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania
Hunter B. Wessells
Department of Urology, University of Washington School of Medicine
Ziya Kirkali
National Institute of Diabetes and Digestive and Kidney Diseases
Charles D. Scales
Departments of Surgery and Population Health Science, Duke Surgical Center for Outcomes Research, Duke Clinical Research Institute, Duke University School of Medicine
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.
