Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTS.
Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTS.
复制标题
输尿管镜检查治疗泌尿系结石后支架相关症状增加的危险因素：支架的结果。
DOI：
10.1097/ju.0000000000003183
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
ScalesJr,CharlesD
中科院分区：
文献类型：
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作者：
Harper,JonathanD;Desai,AlanaC;Maalouf,NaimM;Yang,Hongqiu;Antonelli,JodiA;Tasian,GregoryE;Lai,HHenry;Reese,PeterP;Curatolo,Michele;Kirkali,Ziya;Al-Khalidi,HusseinR;Wessells,Hunter;ScalesJr,CharlesD
PurposeThe Study to Enhance UnUnderstanding of Stent Associated Symptoms，旨在确定疼痛和泌尿系统症状的危险因素，以及这些症状如何干扰输尿管镜取石治疗后的日常活动。Materials and MethodsThis prospective observational cohort study招募了4个临床中心年龄≥12岁接受输尿管镜取石术和输尿管支架治疗的患者。参与者报告了基线时、术后第1、3、5天、支架取出时和支架取出后第30天的症状。疼痛强度、疼痛干扰、泌尿系统症状和困扰的结果用多种仪器记录。使用混合效应线性回归模型进行多变量分析，确定与支架相关症状增加相关的特征。结果共有424名参与者入组。平均年龄为49岁（SD 17）; 47%为女性。术后第1天，参与者的支架相关症状显著增加。虽然疼痛强度从术后第1天到术后第5天降低了50%，但疼痛引起的干扰仍然持续升高。在多变量分析中，年龄越大，疼痛强度越低（P= 0.004）。慢性疼痛（P<0.001）、既往严重支架疼痛（P= 0.021）和基线抑郁症状（P<0.001）均与较高的疼痛强度相关。无论是性别，结石的位置，输尿管通路鞘管的使用，也不是支架的特点是驱动程序的支架相关symptoms.ConclusionsIn这个多中心队列，干扰持续存在，即使疼痛强度降低。患者因素（如年龄、抑郁）而非手术因素与症状强度相关。这些发现为以患者为中心的护理提供了基础，并强调了减轻支架相关症状负担的潜在目标。
PurposeThe STudy to Enhance uNderstanding of sTent-associated Symptoms sought to identify risk factors for pain and urinary symptoms, as well as how these symptoms interfere with daily activities after ureteroscopy for stone treatment.Materials and MethodsThis prospective observational cohort study enrolled patients aged ≥12 years undergoing ureteroscopy with ureteral stent for stone treatment at 4 clinical centers. Participants reported symptoms at baseline; on postoperative days 1, 3, 5; at stent removal; and day 30 post–stent removal. Outcomes of pain intensity, pain interference, urinary symptoms, and bother were captured with multiple instruments. Multivariable analyses using mixed-effects linear regression models were identified characteristics associated with increased stent-associated symptoms.ResultsA total of 424 participants were enrolled. Mean age was 49 years (SD 17); 47% were female. Participants experienced a marked increase in stent-associated symptoms on postoperative day 1. While pain intensity decreased ∼50% from postoperative day 1 to postoperative day 5, interference due to pain remained persistently elevated. In multivariable analysis, older age was associated with lower pain intensity (P= .004). Having chronic pain conditions (P< .001), prior severe stent pain (P= .021), and depressive symptoms at baseline (P< .001) were each associated with higher pain intensity. Neither sex, stone location, ureteral access sheath use, nor stent characteristics were drivers of stent-associated symptoms.ConclusionsIn this multicenter cohort, interference persisted even as pain intensity decreased. Patient factors (eg, age, depression) rather than surgical factors were associated with symptom intensity. These findings provide a foundation for patient-centered care and highlight potential targets for efforts to mitigate the burden of stent-associated symptoms.