Category: Clinical Stones: Ureteroscopy

MP24-8 - Longitudinal Assessment of Post-Ureteroscopic Laser Lithotripsy Pain and Opioid Consumption Using Text Messaging: Tailoring Pain Management to the Patient.

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Ureteroscopy with laser lithotripsy (ULL) is the most common surgery for kidney stones.  Despite its minimally invasive nature, ULL may cause significant postoperative pain (POP), for which opioids are commonly prescribed. However, given the ambulatory nature of ULL the natural history of POP and postoperative opioid consumption (POOC) after ULL is poorly defined. The purpose of this study was to obtain real-time POP and POOC data using a novel automated text messaging system with the ultimate goal improved patient counseling and decreased rates of opioid prescription.


Methods :

Consecutive patients undergoing ULL for stones were prospectively asked to enroll in a post-ULL text messaging study. Patients received and responded to a twice daily text message-based pain assessment (0-10) and daily opioid consumption inquiry (# pills/day) through postoperative day (POD) 14. All patients were discharged with 30 pills of hydrocodone-acetaminophen. POP and POOC were charted as a function of time and univariable and multivariable analysis was performed to identify predictors of decreased time to POP resolution and increased POOC.


Results :

46 patients were included in the study. Table 1 contains stone, demographic, and surgical details of the cohort. 75% of patients had POP ≤4 by POD 3, with a median of 7 days until pain resolution (0/10) (Figure 1a).  Median POOC was 10 total pills (Figure 1b), and 63% of all prescribed pills went unused. Increased time to POP resolution was predicted by increased pain at time of surgery (HR=0.7; p<0.001) and opioid consumption at time of surgery (HR=0.36; p<0.004), while increased POOC was predicted by increased pain at time of surgery (p<0.001), presence of any opioid consumption at time of surgery (HR=0.36; p<0.004), and quantity of opioid consumption at time of surgery (p<0.001). Pre-op renal drainage decreased time to POP resolution (HR=2.29; p=0.017) and POOC (p=0.018). 


Conclusions :

Three-quarters of patients have POP ≤4 by POD 3, median POOC was 10 pills, and 63% of all prescribed pills went unused. Pre-op pain, pre-op opioid use, and pre-op renal drainage were predictive of POP and POOC. 

Kevin J. Flynn

Urology Resident
University of Iowa Department of Urology
Iowa City , Iowa

Kevin J. Flynn, MD Resident Physician, Department of Urology, University of Iowa Class of 2021
Indiana University School of Medicine Class of 2015
Marquette University Class of 2011

Chad Tracy

Assosciate Professor
University of Iowa Department of Urology
Iowa City, Iowa

Bradley Erickson

Assosciate Professor
University of Iowa Department of Urology
Iowa City, Iowa

Paul Guidos

Resident Phyician
University of Iowa Department of Urology
Iowa City, Iowa

Philip Polgreen

Associate Professor of Internal Medicine - Infectious Diseases Associate Professor of Epidemiology
University of Iowa Department of Internal Medicine
Iowa City, Iowa