Stent Duration and Increased Pain in the Hours after Ureteral Stent Removal: An EDGE Multi-Institutional Survey
Michael E. Rezaee, MD, MPH1; Annah J. Vollstedt, MD1; Rajiv Raghavan, BS1; Manoj Monga, MD2; Anna Zampini, MD; MBA; MS2, Ojas Shah, MD3; Amy Krambeck, MD4; Roger Sur, MD5; Stephanie Thompson, MS3, Tammer Yamany, MD6; Vernon Pais, Jr., MD1
1Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2Cleveland Clinic, Cleveland, OH; 3Columbia University, New York, NY; 4Indiana University, Indianapolis, IN; 5University of California San Diego, San Diego, CA; 6Massachusetts General Hospital, Boston, MA
Title: Stent Duration and Increased Pain in the Hours after Ureteral Stent Removal: An EDGE Multi-Institutional Survey
Background: Factors associated with pain after ureteral stent removal have not been well elucidated. Stent duration may have a significant impact on pain after stent removal. We aimed to understand the relationship between pain after ureteral stent removal and duration of stent placement, method of removal, patient age and gender.
Methods: A survey designed to assess the relationship between quality of life and subsequent treatment decisions was distributed to patients 18 years of age and with a history of a ureteral stent across seven academic medical centers across the U.S. participating in the Endourology Disease Group for Excellence (EDGE) Consortium between July 2016 and January 2018. Responses were encoded in duplicate and cross-referenced to ensure accuracy. Statistical analyses were performed using Chi-square and multiple logistic regression.
Results: A total of 272 completed surveys were analyzed. Twenty six percent of patients reported increased pain in the hours after ureteral stent removal. A negative trend was observed in the proportion of patients reporting pain after stent removal by duration of time spent with a stent, as defined by a few days (35.5%), about one week (31.0%), and more than a week (22.2%, p=0.17). Patients with a stent one week or less were significantly more likely to experience pain after stent removal compared to those with a stent more than one week (33.0% vs. 21.2%, p=0.04). After adjustment for age, sex, and health status, patients with a stent more than one week were significantly less likely to report pain in the hours after stent removal (OR: 0.57, 95% CI: 0.32-0.99). Women were 88% more likely to experience pain after ureteral stent removal, but this finding did not persist after adjustment (OR: 1.73, 95% CI: 0.98-3.1) After adjustment, age was negatively associated with pain after stent removal (OR: 0.60, 95% CI: 0.41-0.88).
Conclusions: Approximately, one in four patients will experience increased pain after ureteral stent removal. Patients with a shorter duration of ureteral stent placement and who are younger may be more likely to experience an increase in pain in the hours after stent removal. With increased emphasis on setting post-procedural expectations for pain across multiple clinical disciplines, an understanding of factors associated with post-stent removal pain could be helpful in appropriately counselling and managing patients at high risk for morbidity after stent removal.
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