Category: Clinical Stones: Equipment (stents, lasers, guidewires, sheaths)
Introduction & Objective :
Severe pain after ureteral stent removal is a common, yet under-reported problem. Our objective was to determine the incidence as well as factors associated with the development of severe renal colic after ureteral stent removal.
Methods : This is an IRB exempt quality improvement project. A total of 68 consecutive patients who underwent ureteroscopy and stent placement for renal or ureteral stones from October 2017 to April 2018 were prospectively enrolled. Pre-operative depression and anxiety were assessed using the patient health questionnaire (PHQ-9) and State-Trait Anxiety Inventory (STAI), respectively. Wisconsin quality of life (WISQOL) and Visual analog scale (VAS) for pain was administered pre-operatively and post-operatively before office stent removal. VAS was also administered by telephone 24 hours after stent removal. Severe pain was defined as VAS ≥7. Complications associated with renal colic after stent removal were additionally recorded. Continuous variables were analyzed using either the Student’s T-test or Mann-Whitney U test. Categorical variables were analyzed using Chi-square or Fisher’s exact test. Univariable and multivariable logistic regression was used to evaluate predictors of renal colic. Statistical significance was considered at p≤0.05.
54 (78%) patients were successfully contacted 24 hours after ureteral stent removal. Severe pain within 24 hours of stent removal occurred in 43% of patients (23/54). A total of 6 patients (11%) experienced renal colic that was not alleviated with oral pain medications: 3 returned to the office for IM ketorolac injections and another 3 presented to the emergency department the day of stent removal. No differences were detected in age, BMI, gender, or stone size between patients with and without severe pain after stent removal. WISQOL scores, anxiety, and depression rates were comparable between the 2 groups. Patients who reported pain after stent removal had higher mean VAS scores immediately prior to stent removal (4.7 vs. 2.7, p=0.01) and had a shorter stent dwell time (7.2 vs. 9.8 days, p=0.01) than those not reporting pain after stent removal. No patient with a stent indwelling ≥2 weeks reported severe renal colic. Time to stent removal was the only significant independent factor on multivariable analysis that predicted post-stent removal renal colic (OR 0.71, p=0.04).
Conclusions : Severe pain 24 hours after ureteral stent removal is a common, transient, post-operative problem after ureteroscopy. Leaving stents indwelling for a longer period of time is associated with less risk of severe pain.
Ryan Steinberg– Endourology Fellow, UT Southwestern, Dallas, Texas
Igor Sorokin– Dallas, Texas
Brett Johnson– Endourology Fellow, UT Southwestern, Dallas, Texas
Jodi Antonelli– Assistant professor urology, UT Southwestern, Dallas, Texas
Margaret Pearle– Dallas, Texas
Ryan L. Steinberg MD is a fellow in Endourology and Minimally Invasive Surgery at the University of Texas Southwestern.
Brett Johnson, is the current second-year Endourology fellow at University of Texas Southwestern with Drs. Jeffrey Cadeddu and Margret Pearle. He completed residecny in Urology at the University of Wisconson.
Assistant professor urology
Jodi Antonelli, M.D. is an Assistant Professor in the Department of Urology at UT Southwestern Medical Center. She specializes in the medical and surgical management of kidney stone disease.
Dr. Antonelli earned her medical degree from Jefferson Medical College of Thomas Jefferson University. She completed a general surgery internship and a urology residency at Duke University Medical Center. She completed a fellowship in endourology and stone disease in the Department of Urology at UT Southwestern.
Her research interests include evaluation of dietary and medical therapies for kidney stone prevention, assessment of outcomes for minimally invasive surgical treatments, and development and assessment of surgical innovation. She was the recipient of the 2014 Elisabeth Pickett Research Award for the Society of Women in Urology.
Dr. Antonelli is a member of the American Urological Association, the Endourological Society, and ROCK Society.