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| Peak stent discomfort occurs early and ureteral stent with distal loop design has less pain-A pilot prospective randomised single-blinded trial over 2 weeks |
Kheng Sit Lima,*( ),Zhi Wei Lawa,Marcus Way Lunn Chowb,Allen Soon Phang Sima,Henry Sun Sien Hoa
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aDepartment of Urology, Singapore General Hospital, Singapore
bDepartment of Urology, Tan Tock Seng Hospital, Singapore |
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Abstract Objectives: The Polaris? loop ureteric stent reduces the severity of stent discomfort by minimising stent material in the bladder. Early impact of ureteral stenting on quality of life (QoL) within 1 week remains unclear. The usefulness of the patient-administered ureteral stent symptoms questionnaire (USSQ) during this period of stent insertion was assessed. In this pilot single-blinded prospective randomised study, we investigate 1) the presence of early (within the 1st week) stent discomfort via the visual analog scale (VAS); 2) determine the QoL of the loop stent against conventional stent.
Methods: Forty adults requiring retrograde unilateral ureteral stent placements were enrolled. Patients with single ureteric stone or benign stricture were selected. Patients were randomised in 1:1 ratio to the loop and pigtail arm. The USSQ was administered before placement (baseline), USSQ and VAS were administered on Day 3, 7, and 14.
Results: There were no significant differences between the USSQ scores. Median pain scores on Day 3 were lower in the loop stent group (2.9 vs. 4.0, p=0.047). There was a significant reduction in pain from Day 3-7 (0 vs. -1, p=0.016) in the pigtail group. Conclusions: Our results suggest that peak stent discomfort occurs but resolves quickly within 1 week of post-stent insertion. The loop stent offers a better pain profile compared with conventional stents at Day 3 but no difference in QoL. The loop stent reduces early pain experience post-stent insertion and may have a role in the care of patients who experience significant stent discomfort previously.
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Received: 19 August 2018
Available online: 30 September 2019
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Corresponding Authors:
Kheng Sit Lim
E-mail: jay.lim.k.s@singhealth.com.sg
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Polaris? loop ureteral stent and conventional pigtail ureteral stent.
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Consort diagram of the study. LL, laser lithotripsy; URS, ureteroscopy; UTI, urinary tract infection; USSQ, ureteral stent symptoms questionnaire; VAS, visual analog scale.
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| Loop stent (n=20) | Conventional stent (n=18) | p-Value | | Gender (male/female) | 14/6 | 14/4 | 0.719 | | Mean age (range), year | 50 (29-70) | 52 (29-77) | 0.867 | | Ureteroscopy and laser lithotripsy | 16 | 17 | 0.344 | | Ureteroscopy | 0 | 1 | 0.474 | | Retrograde intrarenal surgery | 2 | 0 | 0.488 | | Previous ureteric stenting | 2 | 0 | 0.488 | | Stent duration, mean±SD, day | 19±8.29 | 25±11.13 | 0.083 |
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Baseline demographic.
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| Loop (n=20) | Control (n=18) | p-Value | | Median VAS3 (interquartile range) | 2.9 (0.5-4) | 4 (3-6) | 0.047 | | Median VAS7 (interquartile range) | 2.6 (1-4) | 2.6 (1.4-5) | 0.670 | | Median VAS14 (interquartile range) | 2 (0-4) | 2.9 (1-4.8) | 0.422 | | Median difference VAS7 & VAS3 (interquartile range) | 0 (-0.8-1.2) | -1 (-2-0) | 0.016 | | Median difference VAS14 & VAS3 (interquartile range) | 0 (-1.4-0.1) | -1 (-2.4-0) | 0.139 | | Median difference VAS14 & VAS7 (interquartile range) | -0.5 (-1-0) | 0 (-1-0) | 0.671 |
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VAS score.
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| Loop (n=20) | Control (n=18) | p-Value | | Median USSQ3 (interquartile range) | 82 (65.2-94.1) | 86.5 (75.9-95) | 0.650 | | Median USSQ7 (interquartile range) | 81.5 (61.5-98) | 81.0 (69-95) | 0.942 | | Median USSQ14 (interquartile range) | 77.1 (58-93) | 81.2 (70-91) | 0.466 | | Median differences USSQ7 & USSQ3 (interquartile range) | 2.2 (-10-13) | -3 (-9.8-0) | 0.357 | | Median differences USSQ14 & USSQ3 (interquartile range) | -2 (-15-3) | -2.5 (-7.5-4) | 0.975 | | Median differences USSQ14 & USSQ7 (interquartile range) | -4 (-11-3.8) | -1 (-7-0) | 0.456 |
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USSQ scores.
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| Adjusted coefficient (95% CI) | p-Value | | USSQ | | Stent type | -1.42 (-14.62 to 11.79) | 0.834 | | Time | -0.29 (-0.66 to 0.09) | 0.133 | | Baseline score | 0.32 (0.06 to 0.60) | 0.018 | | VAS | | Stent type | -0.64 (-2.16 to 0.88) | 0.408 | | Time | -0.06 (-0.11 to -0.01) | 0.018 |
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Multivariate analyses of USSQ and VAS.
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