Tasian Gregory E, Harper Jonathan D, Al-Khalidi Hussein R, Yang Hongqiu, Maalouf Naim M, Curatolo Michele, Lai H Henry, Desai Alana, Antonelli Jodi A, Huang Jing, Ziemba Justin B, Wessells Hunter, Kirkali Ziya, Scales Charles D, Reese Peter P
Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
J Urol. 2025 Apr;213(4):475-484. doi: 10.1097/JU.0000000000004370. Epub 2024 Dec 9.
We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement.
The development cohort included 424 adults and adolescents enrolled in the multicenter STENTS prospective cohort study who underwent ureteroscopy with stent placement for urinary stones. The validation cohort was an independent prospective cohort of 115 adults. The outcomes were severe pain intensity and pain interference, measured by the Patient-Reported Outcomes Measurement Information System, and severe urinary symptoms, measured by the Ureteral Stent Symptom Questionnaire. The top quartile of symptoms on postoperative days 1 and 3 was defined as severe. Generalized estimating equation models were used to predict severe symptoms on postoperative days 1, 3, 5, and 7 to 9 in the development cohort and severe pain interference on days 1 and 7 in the validation cohort.
Female sex, younger age, higher BMI, baseline pain interference, number of chronic pain conditions, renal stone location, and history of anxiety predicted severe pain. In the development cohort, the C statistics were 0.83 (95% CI 0.80-0.85) for severe pain interference and 0.82 (95% CI 0.79-0.84) for severe pain intensity. A model in which baseline urinary symptoms replaced pain interference had excellent discrimination for severe urinary symptoms (C statistic 0.83; 95% CI 0.81-0.85). In the validation cohort, the C statistic was 0.7 for severe pain interference (95% CI 0.54-0.78).
Preoperative characteristics accurately predicted severe pain and urinary symptoms after ureteroscopy with stent placement. On further validation, these models could guide clinical decisions to improve surgical outcomes.
我们开发了输尿管镜置入输尿管支架后严重疼痛和泌尿系统症状的预测模型。
开发队列包括424名成人和青少年，他们参与了多中心STENTS前瞻性队列研究，因尿路结石接受了输尿管镜支架置入术。验证队列是一个由115名成人组成的独立前瞻性队列。结局指标为严重疼痛强度和疼痛干扰，通过患者报告结局测量信息系统进行测量，以及严重泌尿系统症状，通过输尿管支架症状问卷进行测量。术后第1天和第3天症状处于前四分位数被定义为严重。在开发队列中，使用广义估计方程模型预测术后第1、3、5天以及第7至9天的严重症状，在验证队列中预测第1天和第7天的严重疼痛干扰。
女性、年轻、较高的体重指数、基线疼痛干扰、慢性疼痛状况数量、肾结石位置和焦虑史可预测严重疼痛。在开发队列中，严重疼痛干扰的C统计量为0.83（95%CI 0.80 - 0.85），严重疼痛强度的C统计量为0.82（95%CI 0.79 - 0.84）。一个用基线泌尿系统症状替代疼痛干扰的模型对严重泌尿系统症状具有出色的区分能力（C统计量0.83；95%CI 0.
