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Impact of prior ureteral stent on future treatment decisions: EDGE multi-institutional survey
Annah J. Vollstedt, MD¹, Rajiv Raghavan, BS¹, Manoj Monga, MD², Anna Zampini, MD, MBA, MS², Ojahs Shah, MD³, Rafael Yanes, MD³, Stephanie Thompson, MS³, Amy Krambeck, MD⁴, Vernon Pais, Jr., MD¹.
¹Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, ²Cleveland Clinic, Cleveland, OH, USA, ³Columbia Univerisity, New York, NY, USA, ⁴Indiana Univerisity, Indianapolis, IN, USA.

INTRODUCTION: While well recognized that ureteral stents cause significant postoperative discomfort, implications of their impact on quality of life have not been fully evaluated. In particular, it is unknown whether prior stent experience affects subsequent treatment decisions. We previously developed and validated a survey to assess the effect of prior experience on willingness to undergo future stone therapy in general, and willingness to accept higher postoperative risks in order to forgo stent placement in particular. METHODS: The survey assessing the impact of decreased quality of life on subsequent treatment decisions was distributed to patients with a history of ureteral stent at four geographically disparate academic centers between July and October 2016. Responses were encoded in duplicate to ensure accuracy. Statistical analysis was performed using Chi square analyses. RESULTS: A total of 155 surveys were completed. Assessing prior stent experience, those reporting more pain with the stent were less likely to accept surgery for an asymptomatic stone (p=0.001). When informed that ureteroscopy with stent omission would have a small increased risk of unplanned return visit compared with ureteroscopy with a stent, 26% chose surgery without a stent. Although not statistically significant, the percentage increased to 34% when assessing only those who reported worse pain with the stent than the stone. Conversely, of those that reported worse pain with the stone, only 19% chose surgery without a stent. When assessing impact of quality of life changes, only decreased interest in socializing (p=0.011) was associated with a higher likelihood to choose stent omission understanding this may entail greater risk of unplanned hospital return. Other consequences of stent placement (e.g. missed work, inability to care for family, exercising less, and decrease sexual activity) were not associated with a higher likelihood of choosing surgery without a stent. CONCLUSIONS: Patients experiencing more pain with their stent than the inciting stone are less willing to treat asymptomatic renal stones. The impact of the stent on decreased socializing was noted to increase likelihood to accept greater perioperative risks in order to omit stent placement. With increased emphasis on shared medical decision making, an enhanced understanding of factors affecting these decisions is important in order to appropriately counsel patients.

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