Gregory E Tasian, Jonathan D Harper, Hussein R Al-Khalidi, Hongqiu Yang, Naim M Maalouf, Michele Curatolo, H Henry Lai, Alana Desai, Jodi A Antonelli, Jing Huang, Justin B Ziemba, Hunter Wessells, Ziya Kirkali, Charles D Scales, Peter P Reese
{"title":"输尿管镜下输尿管支架置入后严重疼痛和泌尿系统症状预测模型的建立:来自支架研究的结果和疼痛干扰的初步验证。","authors":"Gregory E Tasian, Jonathan D Harper, Hussein R Al-Khalidi, Hongqiu Yang, Naim M Maalouf, Michele Curatolo, H Henry Lai, Alana Desai, Jodi A Antonelli, Jing Huang, Justin B Ziemba, Hunter Wessells, Ziya Kirkali, Charles D Scales, Peter P Reese","doi":"10.1097/JU.0000000000004370","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"475-484"},"PeriodicalIF":5.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888894/pdf/","citationCount":"0","resultStr":"{\"title\":\"Development of Prediction Models for Severe Pain and Urinary Symptoms After Ureteroscopy With Ureteral Stent Placement: Results From the STENTS Study and Initial Validation of Pain Interference.\",\"authors\":\"Gregory E Tasian, Jonathan D Harper, Hussein R Al-Khalidi, Hongqiu Yang, Naim M Maalouf, Michele Curatolo, H Henry Lai, Alana Desai, Jodi A Antonelli, Jing Huang, Justin B Ziemba, Hunter Wessells, Ziya Kirkali, Charles D Scales, Peter P Reese\",\"doi\":\"10.1097/JU.0000000000004370\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":17471,\"journal\":{\"name\":\"Journal of Urology\",\"volume\":\" \",\"pages\":\"475-484\"},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888894/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JU.0000000000004370\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/9 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JU.0000000000004370","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/9 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:我们建立输尿管镜下置入输尿管支架后严重疼痛和泌尿系统症状的预测模型。材料和方法:发展队列包括424名成人和青少年,他们参加了多中心支架前瞻性队列研究,接受输尿管镜检查并放置支架治疗尿路结石。验证队列是一个独立的前瞻性队列,包括115名成年人。结果为重度疼痛强度和疼痛干扰(由PROMIS测量)和重度泌尿系统症状(由输尿管支架症状问卷测量)。术后第1天和第3天症状的前四分位数被定义为严重。应用广义估计方程模型预测发展组术后第1、3、5和7-9天的严重症状,以及验证组第1和7天的严重疼痛干扰。结果:女性、年轻、较高的体重指数、基线疼痛干扰和慢性疼痛状况的数量、肾结石的位置和焦虑史预测严重疼痛。在发展队列中,严重疼痛干扰组的c统计值为0.83 (95% CI 0.80-0.85),严重疼痛强度组的c统计值为0.82 (95% CI 0.79-0.84)。基线尿路症状替代疼痛干扰的模型对严重尿路症状有很好的鉴别(c统计量0.83;95% ci 0.81-0.85)。在验证队列中,严重疼痛干扰的c统计量为0.7 (95% CI 0.54-0.78)。结论:术前特征准确预测输尿管镜置入支架后的剧烈疼痛和泌尿系统症状。经过进一步验证,这些模型可以指导临床决策以改善手术结果。
Development of Prediction Models for Severe Pain and Urinary Symptoms After Ureteroscopy With Ureteral Stent Placement: Results From the STENTS Study and Initial Validation of Pain Interference.
Purpose: We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement.
Materials and methods: 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.
Results: 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).
Conclusions: 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.
期刊介绍:
The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.