Stent-Associated Symptoms Following URS: Risk Factors and Patient Outcomes

Question 1

Question 1
Which of the following patient characteristics were associated with having significantly higher pain intensity:

Choose one

Baseline depression

Stone location and sheath use

Older age

Ureteroscopy time

Question 2

Q: What happens to pain intensity and interference following stent placement after URS?

Answer 2

Pain intensity spikes on POD 1 and decreases by 50% by POD 5, but pain interference remains elevated longer.

Question 3

Which patient factors are linked to higher pain intensity following URS and stent placement?

Answer 3

A: Chronic pain conditions, prior severe stent pain, and depression are associated with higher pain intensity.

Question 4

Q: Were stone location, UAS use, or stent characteristics associated with increased stent symptoms?

Answer 4

A: No, these surgical and stone factors were not significant contributors to stent-associated symptoms.

Question 5

Q: What effect does age have on stent-associated pain after URS?

Answer 5

A: Older age is associated with lower pain intensity, though pain interference may still persist.

Question 6

Q: What percentage reduction in pain intensity is typically seen by POD 5?

Answer 6

A: A 50% reduction from POD 1 levels.

Question 7

1. Card 1: Post-URS Symptom Peak
   
   • Q: When do stent-associated symptoms peak after URS?

Answer 7

A: Postoperative Day 1 (POD 1).

Question 8

2. Card 2: Pain Intensity Reduction by POD 5
   
   • Q: By how much does pain intensity typically decrease by POD 5 after URS and stent placement?

Answer 8

A: 50% reduction from POD 1.

Question 9

3. Card 3: Pain Interference Beyond POD 5
   
   • Q: How does pain interference evolve beyond POD 5 after stent placement?

Answer 9

A: It remains elevated even as pain intensity decreases.

Question 10

4. Card 4: Urinary Symptom Trends
   
   • Q: What happens to urinary symptoms after POD 5 following stent placement?

Answer 10

A: They decrease but remain elevated until stent removal.

Question 11

5. Card 5: Impact of Older Age on Pain Intensity
   
   • Q: How does older age affect pain intensity following URS and stent placement?

Answer 11

A: Older age is associated with lower pain intensity.

Question 12

6. Card 6: Chronic Pain and Stent Pain History
   
   • Q: Which two patient factors are linked to higher pain intensity after URS and stent placement?

Answer 12

A: Chronic pain conditions and prior severe stent pain.

Question 13

7. Card 7: Depression and Pain Intensity
   
   • Q: How does baseline depression affect stent-associated symptoms?

Answer 13

A: Depression is associated with higher pain intensity.

Question 14

8. Card 8: Effect of BMI on Urinary Symptoms
   
   • Q: Which factor is linked to urinary bother following stent placement after URS?

Answer 14

A: Higher BMI.

Question 15

9. Card 9: Predictors of Higher Urinary Bother
   
   • Q: What two factors contribute to increased urinary bother following URS and stent placement?

Answer 15

A: BMI and baseline depression.

Question 16

11. Card 11: Sex Differences in Stent Symptoms
    
    • Q: Was there a significant difference in stent-associated symptoms based on sex?

Answer 16

A: No, sex did not influence stent-associated symptoms.

Question 17

10. Card 10: UAS Use and Stent-Associated Symptoms
    
    • Q: Did ureteral access sheath (UAS) use correlate with increased stent-associated symptoms?

Answer 17

A: No, UAS use did not significantly affect symptom intensity.

Question 18

12. Card 12: Surgical and Stone Factors
    
    • Q: Were stone location or stent characteristics associated with increased symptoms after URS?

Answer 18

A: No, surgical and stone factors did not play a significant role.

Question 19

13. Card 13: Importance of Patient Factors in Symptoms
    
    • Q: What played a more significant role in post-URS stent symptoms, patient factors or surgical factors?

Answer 19

A: Patient factors, like age and depression, were more significant.

Question 20

14. Card 14: Older vs. Younger Patients in Symptom Severity
    
    • Q: How do older patients’ symptom experiences compare to younger patients following URS?

Answer 20

A: Older patients had lower pain intensity, but younger patients experienced greater symptom burden.

Question 21

15. Card 15: Time Course of Pain and Urinary Symptoms
    
    • Q: How do pain and urinary symptoms evolve in the immediate postoperative period after URS and stent placement?

Answer 21

A: Pain intensity decreases rapidly by POD 5, but pain interference and urinary symptoms persist longer.

Question 22

16. Card 16: Pain Interference and Daily Activities
    
    • Q: Despite a reduction in pain intensity, what symptom remains problematic after POD 5?

Answer 22

A: Pain interference with daily activities remains elevated.

Question 23

17. Card 17: Role of BMI in Symptom Severity
    
    • Q: How does BMI affect post-URS symptoms?

Answer 23

A: Higher BMI is linked to greater urinary bother.

Question 24

18. Card 18: Patient Counseling Importance
    
    • Q: What do the study’s findings suggest for patient counseling post-URS and stent placement?

Answer 24

A: Patients should be counseled on symptom persistence, particularly pain interference and the effects of age, chronic pain, and depression.

Question 25

19. **Card 19: Future Efforts in Reducing Stent Symptoms** - **Q**: What future efforts are highlighted to mitigate the burden of stent-associated symptoms?

Answer 25

A: Prediction modeling for those at risk of severe pain and targeting patient factors like depression.

Question 26

Q: What is the primary purpose of ureteral stents after URS?

Answer 26

A: To ensure ureteral patency and facilitate healing if injury occurs. Memory aid: Think of a "stent" like a "tent" that holds up the structure (ureter) while it heals.

Question 27

Q: How do stent-associated symptoms vary among patients?

Answer 27

A: Some patients tolerate stents well, while others experience severe pain and urinary symptoms that interfere with daily activities. Memory aid: "Stent symptoms" can be either "silent" or a "storm" depending on the patient.

Question 28

Q: What is the primary purpose of ureteral stents following ureteroscopy (URS)?

Answer 28

A: Ureteral stents are used to maintain ureteral patency and aid healing if any ureteral injury occurs during the procedure.

Question 29

Q: Why is understanding the etiology of stent-associated symptoms difficult?

Answer 29

A: Understanding is challenging because there are multiple modifiable and non-modifiable risk factors, including patient demographics, baseline pain, psychosocial factors, stone characteristics, operative factors, stent characteristics, and medications.

Question 30

Q: List two modifiable and non-modifiable risk factors that affect stent-associated symptoms.

Answer 30

- **A**: - **Modifiable**: **Psychosocial factors** (e.g., depression), **medications**. - **Non-modifiable**: **Age**, **stone characteristics** (e.g., size, location).

Question 31

Q: What is the overall aim of the STENTS study?

Answer 31

- **A**: To **identify risk factors** for increased **pain**, **pain interference**, **urinary symptoms**, and **bother** following **ureteroscopy (URS)** and **stent placement**, and to **inform future interventional studies**.``

Question 32

Q: Which network conducted the STENTS study?``

Answer 32

A: The USDRN (Urinary Stone Disease Research Network) conducted the study.

Question 33

Q: What type of study was conducted in the STENTS study?

Answer 33

A: A prospective, observational cohort study.

Question 34

Q: Why are modifiable risk factors important in managing stent-associated symptoms?

Answer 34

A: Modifiable factors such as psychosocial health and medications can be adjusted to reduce symptom burden and improve patient outcomes.

Question 35

Q: How can understanding non-modifiable factors help clinicians in managing stent-associated symptoms?

Answer 35

- **A**: Knowing **non-modifiable factors**, such as a patient's **demographics** or **stone characteristics**, helps identify individuals who are more likely to experience severe symptoms, allowing for better **patient counseling** and **symptom management**.

Question 36

10. **Q**: Why is **symptom burden** such a significant issue for patients with ureteral stents? - **A**: Because **stent-associated pain** and **urinary symptoms** can significantly affect **quality of life** and daily activities, leading to poor patient outcomes if not properly managed.