Predicting procedural pain after ureteroscopy: does hydrodistention play a role?

Abstract

Purpose:To identify perioperative predictors of immediate pain after ureteroscopy, specifically evaluating the impact of hydrodistention from irrigation on pain.Materials and Methods:We retrospectively identified patients who underwent ureteroscopy for the treatment of calculi. Data recorded for these patients included their maximum pain score in the post-anesthesia care unit (PACU), average flow rate of irrigant used during the procedure, patient and stone characteristics, operative procedure, and details of patients' immediate, post-operative course. Spearman's rho was used to determine the relationship between non-parametric, continuous variables. Then, a linear regression was performed to assess which variables could predict the peak pain score.Results:A total of 131 patients were included in the study. A non-parametric correlation analysis revealed that maximum pain score was negatively correlated with being male (r = −0.18, p=0.04), age (r = −0.34, p<0.001), and post-op foley placement (r = −0.20, p=0.02) but positively correlated with the preoperative pain score (r = 0.41, p<0.001), time in the PACU (r = 0.19, p = 0.03), and the morphine equivalent dose (MED) of narcotics administered in the PACU (r = 0.67, p<0.001). On linear regression, the significant variables were age, preoperative pain score, and stent placement. For every ten-year increase in age post-operative pain score decreased by 4/10 of a point (p = 0.03). For every 1 point increase in preoperative pain score there was a 3/10 of a point increase in the maximum pain score (p = 0.01), and leaving a stent in place post-operatively was associated with a 1.6 point increase in the maximum pain score.Conclusions:Hydrodistention does not play a role in post-ureteroscopy pain. Patients who are younger, have higher preoperative pain scores, or who are stented will experience more post-operative pain after ureteroscopy.

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

“…To date, little is known about risk factors for severe SAS, and further investigation is needed. Younger age has been reported to be associated with more severe pain and unplanned hospital visits [ 13 – 15 ]. Krambeck and colleagues, in a subset analysis, reported decreased analgesic use in young males who had a ketorolac-loaded stent, suggesting potential gender differences in stent tolerance [ 16 ].…”

Assessment of Patient and Surgical Variables Including Residency Training Level on Adverse Events After Ureteroscopy for Ureteral Stones: A Multivariate Analysis

“…Several studies have attempted to characterize the postoperative complications and readmission rates relative to technical difficulty of the procedure such as stone size, composition, and location but no standard conclusions have been made. [5][6][7] Studies have indicated that high-volume centers report a lower complication rate after stone surgery, implying that experience with the procedure may play a role. 5 One analysis by Netsch and colleagues suggested that fellowship training in Endourology did not affect complication rate and that, with standardized training protocols, residents performing surgery did not have increased complication rates compared with that of board-certified urologists.…”

Randomized Controlled Trial of Single-dose Perioperative Pregabalin in Ureteroscopy

“…In ureteroscopy, younger age has been shown to be associated with increased postoperative pain, with a 0.4 point difference for every 10 years of age. 30 Therefore, our primary outcome is likely biased toward demonstrating more of a difference than there would be had the groups been balanced (essentially a type 1 error). To attempt to account for this, we performed a post hoc multivariable analysis, which continued to demonstrate increased pain scores in the patients receiving pregabalin, despite controlling for age and preoperative pain scores.…”