Pain is Independent of Stone Burden and Predicts Surgical Intervention in Patients with Ureteral Stones

Portis, Jennifer; Neises, Suzanne; Portis, Andrew J.

doi:10.1016/j.juro.2018.04.075

Cited by 15 publications

(7 citation statements)

References 29 publications

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“…11 However, Jennifer et al studied 650 patients with ureteral stones and found no significant correlation between stone size, localization, or pain severity. 12 In our study, while the size of the ureteral stones increased in correlation with the VAS pain score, this correlation was not seen for renal stones ( r =0.34 p < 0.001, r =–0.027, p = 0.64). In the comparison of stone localization and pain severity, while the distal ureteral stones were the most painful (VAS score 10 cm), the decrease in pain intensity was listed as proximal (VAS score 8.5 cm) - middle ureter (VAS score 7.7 cm) ( p < 0.001).…”

Section: Discussioncontrasting

confidence: 58%

Clinical Score Application for Abdominopelvic Computed Tomography Used in the Diagnosis of Renal Colic Patients

Gonullu

Selvi²,

Bedel³

2022

Ibnosina Journal of Medicine and Biomedical Sciences

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Background To develop risk scoring for the use of computed tomography (CT) imaging using the visual analog scale (VAS), physical examination, and laboratory findings of renal colic patients admitted to the emergency department (ED). Materials and Methods This is prospective observational study. Among the patients who presented to the ED with abdominal or flank pain, patients who were scheduled for CT imaging for urolithiasis were included in the study. The mean VAS pain scores, physical examination findings, laboratory parameters, and macroscopic and microscopic values in urinalysis were compared between the two groups with and without stones on CT. Results Of the 196 urolithiasis patients included in the study, 165 had ureteral stones, 76 had renal stones, and 45 had renal and ureteral stones. While the difference between the urine erythrocyte averages of the two groups was borderline significant (p = 0.04), there was a high difference between the urinary hemoglobin amounts (p < 0.001). In patients with urinary system stone disease, hydronephrosis, and ureteral dilatation, hemoglobin ++ and above were more significant (p < 0.001). For ureteral stones, pain intensity increased as the size increased (r = 0.34 p < 0.001). White blood cells > 10,000 103/mL, and C-reactive protein (CRP) ≤ 5 mg/L were more significant in patients with acute renal colic. Conclusions Although we cannot develop a clinical scoring system for renal colic patients, the meaningful results we found for urinary stone disease can be used in a newly developed scoring system. It can be used in new scoring systems in the ED using a high VAS score, presence and amount of urine hemoglobin, CRP) ≤ 5 mg/L, and creatinine value.

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Section: Discussioncontrasting

confidence: 58%

Clinical Score Application for Abdominopelvic Computed Tomography Used in the Diagnosis of Renal Colic Patients

Gonullu

Selvi²,

Bedel³

2022

Ibnosina Journal of Medicine and Biomedical Sciences

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“…Pain intensity and interference were also measured with individual PROMIS instruments, allowing for comparison with population norms. Recently, PROMIS measures have been used to characterize stone patients in various settings [ 18 – 20 ]. In our study, we noted consistency among instruments in ascertaining peak symptoms, the evolution of daily symptoms, and the heterogeneity of the lived experiences following URS and stent placement.…”

Section: Discussionmentioning

confidence: 99%

Quality of life impact and recovery after ureteroscopy and stent insertion: insights from daily surveys in STENTS

et al. 2022

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Background Our objective was to describe day-to-day evolution and variations in patient-reported stent-associated symptoms (SAS) in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS), a prospective multicenter observational cohort study, using multiple instruments with conceptual overlap in various domains. Methods In a nested cohort of the STENTS study, the initial 40 participants having unilateral ureteroscopy (URS) and stent placement underwent daily assessment of self-reported measures using the Brief Pain Inventory short form, Patient-Reported Outcome Measurement Information System measures for pain severity and pain interference, the Urinary Score of the Ureteral Stent Symptom Questionnaire, and Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index. Pain intensity, pain interference, urinary symptoms, and bother were obtained preoperatively, daily until stent removal, and at postoperative day (POD) 30. Results The median age was 44 years (IQR 29,58), and 53% were female. The size of the dominant stone was 7.5 mm (IQR 5,11), and 50% were located in the kidney. There was consistency among instruments assessing similar concepts. Pain intensity and urinary symptoms increased from baseline to POD 1 with apparent peaks in the first 2 days, remained elevated with stent in situ, and varied widely among individuals. Interference due to pain, and bother due to urinary symptoms, likewise demonstrated high individual variability. Conclusions This first study investigating daily SAS allows for a more in-depth look at the lived experience after URS and the impact on quality of life. Different instruments measuring pain intensity, pain interference, and urinary symptoms produced consistent assessments of patients’ experiences. The overall daily stability of pain and urinary symptoms after URS was also marked by high patient-level variation, suggesting an opportunity to identify characteristics associated with severe SAS after URS.

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“…Contrarily, a study by Gourlay et al did not find any association between the severity of pain and the need for hospitalisation or rescue intervention within 60 days [ 11 ]. A study by Portis et al found that pain severity was an independent predictor of the need for surgical intervention [ 13 ]. However, a study by Innes et al found that early intervention resulted in higher rates of emergency department revisits and rehospitalization [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Gourlay et al and Splinter et al reported that there was no significant correlation of pain with stone size, location, and patient outcomes. On the other hand, Portis et al in a study found that pain score was an independent predictor of surgical outcome [ 11 - 13 ]. However, a study by Sasmaz and Kirpat found a significant correlation of pain severity with hydronephrosis and biomarkers like C-reactive protein and Neutrophil-Lymphocyte ratio [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Correlation of Severity of Renal Colic With Clinical, Laboratory, and Radiological Parameters: An Emergency Department-Based Prospective Observational Study

Joshi¹,

Kaeley²,

Nagasubramanyam³

et al. 2022

Cureus

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In this study, we investigated the correlation of severity of renal colic with clinical parameters like pain characteristics, haematuria and pyuria, laboratory parameters such as inflammatory markers, and radiological parameters including site and size of stone and hydronephrosis. MethodsThe Visual Analogue Scale (VAS) determined the pain severity. Detailed history and clinicodemographic profiling of the patient was done, laboratory investigations were done, ultrasound and non-contrast computed tomography of kidney-ureter-bladder were done and all the parameters were duly noted and correlated with the pain severity. ResultThe mean age of the 183 patients was 43.96 ± 15.16 years, and 62.8% were male. The patients' mean VAS score at presentation was 8.57 ± 1.08. The mean VAS score was found to be statistically higher in patients having a first episode of renal colic, solitary kidney, pyuria, raised creatinine, severe hydronephrosis, and stones located at the renal pelvis. In addition, higher VAS scores led to more surgical interventions. ConclusionThe correlation of pain severity of renal colic with various parameters can aid in the development of quick diagnostic and therapeutic protocols for patients presenting to the emergency department with renal stone disease. This study shows that pain scores can correlate with various parameters and predict the outcome and complications in these patients.

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Pain is Independent of Stone Burden and Predicts Surgical Intervention in Patients with Ureteral Stones

Abstract: PROMIS pain scores are independent of stone size and location. Attention to emergency department discharge symptom control offers the potential to improve patient care. PROMIS pain intensity is an independent predictor of surgical intervention in patients with ureteral stones 1 cm or less.

Cited by 15 publications

References 29 publications

Clinical Score Application for Abdominopelvic Computed Tomography Used in the Diagnosis of Renal Colic Patients

Clinical Score Application for Abdominopelvic Computed Tomography Used in the Diagnosis of Renal Colic Patients

Quality of life impact and recovery after ureteroscopy and stent insertion: insights from daily surveys in STENTS

Correlation of Severity of Renal Colic With Clinical, Laboratory, and Radiological Parameters: An Emergency Department-Based Prospective Observational Study

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