Postoperative Symptom Severity and Time Course After Bilateral Ureteroscopy With Stents: Results From the Study to Enhance Understanding of Stent-associated Symptoms.

Objective: To assess and compare stent-associated symptoms after unilateral vs bilateral ureteroscopy with ureteral stent placement for stone treatment.

Methods: Participants enrolled in the Study to Enhance Understanding of Stent-Associated Symptoms (STENTS), a multicenter, prospective, observational cohort study, completed validated questionnaires and patient-reported outcome measures to assess stent-associated symptoms postoperatively. Patient-Reported Outcomes Measurement Information System (PROMIS) tools were used to measure pain intensity and interference due to pain, while the Ureteral Stent Symptom Questionnaire (USSQ) and Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10) were used to measure urinary symptoms. These data were used to determine symptom intensity and course, comparing outcomes after bilateral vs unilateral ureteroscopy.

Results: Of the 484 participants who enrolled in STENTS, 60 underwent a bilateral procedure. Patients in the bilateral group reported greater increases in pain intensity and pain interference beginning on POD 3 (P = .017 and .022, respectively), continuing through POD 7-9, with no difference in interference 30 days after stent removal, compared to the unilateral group. Urinary symptoms were worse following a bilateral compared to unilateral procedure at all time points, except for similar urinary symptoms 30 days following stent removal.

Conclusion: Patients undergoing bilateral compared to unilateral ureteroscopy report higher pain intensity, pain interference and urinary symptoms. Although exploratory, this analysis provides the most informative description of the patient experience with bilateral stents to date and may be useful in counseling patients considering bilateral stone treatment and in managing expectations.