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 PROMIS, and severe urinary symptoms, measured by the Ureteral Stent Symptom Questionnaire. The top quartile of symptoms on postoperative days 1 and 3 were defined as severe. Generalized estimating equation models were used to predict severe symptoms on postoperative days 1, 3, 5, and 7-9 in the development cohort and severe pain interference on days 1 and 7 in the validation cohort. RESULTS Female sex, younger age, higher body mass index, baseline pain interference and 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. Upon further validation, these models could guide clinical decisions to improve surgical outcomes.

中文翻译：

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输尿管镜下输尿管镜下放置术后严重疼痛和泌尿系统症状预测模型的开发：STENTS 研究结果和疼痛干扰的初步验证。


目的 我们开发了输尿管镜下输尿管支架置入术后严重疼痛和泌尿系统症状的预测模型。材料和方法 开发队列包括 424 名参加多中心 STENTS 前瞻性队列研究的成人和青少年，他们接受了输尿管镜检查和支架置入治疗尿路结石。验证队列是一个由 115 名成年人组成的独立前瞻性队列。结局是 PROMIS 测量的严重疼痛强度和疼痛干扰，以及通过输尿管支架症状问卷测量的严重泌尿系统症状。术后第 1 天和第 3 天的症状最高四分位数被定义为严重。广义估计方程模型用于预测开发队列术后第 1 、 3、 5 和 7-9 天的严重症状，以及验证队列第 1 天和第 7 天的严重疼痛干扰。结果 女性、年龄较小、体重指数较高、基线疼痛干扰和慢性疼痛状况的数量、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）。基线泌尿系统症状取代疼痛干扰的模型对严重泌尿系统症状有很好的鉴别力（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 术前特征准确预测了输尿管镜支架置入术后严重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。