Abstract
A previous randomized, controlled trial had demonstrated that complete intraureteral stent placement (CIU-SP) was superior to conventional stent placement (C-SP) in terms of improvement of stent-related urinary symptoms. However, it is unclear as to which subdomain symptom and cohort could benefit the most from CIU-SP compared to C-SP in urinary symptoms while considering the baseline urinary status. To determine this, a post-hoc analysis was performed using data from a previous study (CIU-SP group, n = 39; C-SP group, n = 41). We assessed the mean changes in the International Prostate Symptom Score (I-PSS) and the Overactive Bladder Symptom Score (OABSS) from baseline to day 14. Statistical comparison between the two groups was performed using analysis of covariance with adjustment of baseline urinary status as a covariate. Among 80 patients, the total I-PSS was significantly lower in the CIU-SP group than in the C-SP group in the cohort with mild urinary symptoms (P = 0.005), but not in those with moderate/severe symptoms (P = 0.521). The CIU-SP group showed significantly improved I-PSS and OABSS daytime frequencies, with the highest t statistic (2.47 and 2.10, respectively) among subdomains of both symptom scores compared with the C-SP group (both P < 0.001). In multivariate regression analysis, the stent placement method (CIU-SP vs. C-SP) was independently associated with the I-PSS daytime frequency on day 14 (P = 0.017). This study suggests that CIU-SP significantly improved stent-related daytime frequency compared with C-SP, and it may benefit especially those patients who have mild urinary symptoms before the placement of ureteral stents.
Highlights
A previous randomized, controlled trial had demonstrated that complete intraureteral stent placement (CIU-SP) was superior to conventional stent placement (C-SP) in terms of improvement of stent-related urinary symptoms
To appropriately assess the efficacy of CIU-SP in stent-related urinary symptoms To appropriately assess the efficacy of CIU-SP in ameliorating stent-related urinary symptoms and identify the subgroup that could benefit from CIU-SP compared to C-SP, we performed a post-hoc analysis to compare the mean changes in urinary symptom scores from baseline to day 14 between the two stent placement groups, with adjustment of the baseline urinary status as a c ovariable[10]
The mean changes in the International Prostate Symptom Score (I-PSS) and Overactive Bladder Symptom Score (OABSS) in all patients are shown in Fig. 1 and Table 2
Summary
A previous randomized, controlled trial had demonstrated that complete intraureteral stent placement (CIU-SP) was superior to conventional stent placement (C-SP) in terms of improvement of stent-related urinary symptoms. This study suggests that CIU-SP significantly improved stent-related daytime frequency compared with C-SP, and it may benefit especially those patients who have mild urinary symptoms before the placement of ureteral stents. Despite such advantages, this process causes ureteral stent discomfort, such as body pain and impairment of urinary symptoms, and affects the patient’s quality of life (QoL)[4] Most of these symptoms have been considered to be attributed to ureteral spasm or contact of the distal end of the stent on the bladder w all[5]. To appropriately assess the efficacy of CIU-SP in stent-related urinary symptoms To appropriately assess the efficacy of CIU-SP in ameliorating stent-related urinary symptoms and identify the subgroup that could benefit from CIU-SP compared to C-SP, we performed a post-hoc analysis to compare the mean changes in urinary symptom scores from baseline to day 14 between the two stent placement groups, with adjustment of the baseline urinary status as a c ovariable[10]. We examined the most relevant subdomain in urinary symptom scores that is associated with improvement by CIU-SP vs. C-SP
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