Contribution of Hypersensitivity to Postureteroscopy Ureteral Stent Pain: Findings From Study to Enhance Understanding of Stent-associated Symptoms - 27/02/24

Doi : 10.1016/j.urology.2023.10.039

Hing Hung Henry Lai ^a,^⁎ , Hongqui Yang ^b, Gregory E. Tasian ^c,^d, Jonathan D. Harper ^e, Alana C. Desai ^f, Rebecca D. McCune ^c, Ziya Kirkali ^g, Hussein R. Al-Khalidi ^b, Charles D. Scales ^h, Michele Curatolo ^i,^j,^k
NIDDK Urinary Stone Disease Research Network (USDRN)
^a Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, MO
^b Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
^c Division of Urology and Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA
^d Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
^e Department of Urology, University of Washington, Seattle, WA
^f Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
^g National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
^h Departments of Surgery (Urology) and Population Health Science, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
ⁱ Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
^j Harborview Injury Preventions and Research Center, University of Washington, Seattle, WA
^k Center for Sensory-Motor Interaction, University of Aalborg, Aalborg, Denmark

^⁎Address correspondence to: Hing Hung Henry Lai, M.D., Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242-0022-02, St. Louis, MO 63110.Division of Urologic Surgery, Washington University School of Medicine4960 Children’s Place, Campus Box 8242-0022-02St. LouisMO63110

Résumé

Objective

To examine the relationships between preoperative hypersensitivity to pain and central sensitization, and postoperative ureteral stent pain after ureteroscopy (URS) for urinary stones.

Methods

Adults enrolled in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) underwent quantitative sensory testing (QST) prior to URS and stent placement. Hypersensitivity to mechanical pain was assessed using a pressure algometer. Participants rated their pain intensity to pressure applied to the ipsilateral flank area and lower abdominal quadrant on the side of planned stent placement, and the contralateral forearm (control). Pressure pain thresholds were also assessed. Central sensitization was assessed by applying a pointed stimulator (pinprick) and calculating the temporal summation. Postoperative stent pain intensity and interference were assessed using PROMIS questionnaires. Data were analyzed using repeated-measures mixed-effects linear models.

Results

Among the 412 participants, the median age was 54.0years, and 46% were female. Higher preoperative pain ratings to 2 kg and 4 kg mechanical pressure to the ipsilateral flank and abdominal areas were associated with higher postoperative stent pain intensity with the stent in situ. Greater degree of central sensitization preoperatively, manifesting as higher temporal summation, was associated with higher postoperative pain intensity. Factors associated with preoperative hypersensitivity on QST included female sex, presence of chronic pain conditions, widespread pain, and depression.

Conclusion

Hypersensitivity to pain and central sensitization preoperatively was associated with postoperative ureteral stent pain, suggesting a physiologic basis for stent symptom variation. QST may identify patients more likely to develop stent pain after URS and could inform selection for preventive and interventional strategies.

Le texte complet de cet article est disponible en PDF.

Plan

MATERIALS AND METHODS

Study Design and Population

QST Procedures

Outcomes

Patient Factors Associated With Preoperative Hypersensitivity on QST

Statistical Analysis

RESULTS

Association of Preoperative QST and Postoperative PROMIS Pain Intensity

Association of Preoperative QST and Postoperative PROMIS Pain Interference

Patient Factors Associated With Preoperative Hypersensitivity on QST

DISCUSSION

CONCLUSION

Funding Support:This research was supported by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, as follows: U01DK110961 (UPenn/CHOP – Peter P. Reese, MD, PhD; Tasian), U01KD110986 (Washington Univ. St Louis – Lai, Desai), U01DK110994 (UT Southwestern - Naim M. Maalouf, MD), U01DK110954 (University of Washington – Harper, Hunter Wessells, MD), and U01DK110988 (Duke University – Al-Khalidi, Scales). This is a cooperative agreement; there is substantial federal scientific or programmatic involvement in the research activities. The NIDDK Project Scientist (ZK) is involved in the design and development of the clinical protocol, preparation of questionnaires and other data recording forms, coordination of research, statistical evaluations and analyses of data, and the publication of results. The program is overseen by an independent NIDDK Program Official.