Postoperative pain factors after ureterscopic removal of stones in kidney and ureter Authors

Abstract

Objective: Postoperative wpain after ureteroscopic removal of ureter and kidney stones frequently leads to re-hospitalization, revisit and increased cost. However, risk factors and incidence for early postoperative pain are still unclear. The aim of this study is to investigate the associated risk factors and the incidence of acute postoperative pain after ureteroscopic stone removal in the ureter and kidney. Materials and Methods: Retrospective data from 306 consecutive patients who underwent ureteroscopic treatment for ureteral and kidney stones from January 2016 to December 2020 were collected. The patients were divided into two groups: (i) Mild postoperative pain (n = 179), defined as a pain score lower than four on the visual analog pain scale during the first operative day, and (ii) Moderate to severe postoperative pain (n = 127) was defined as a pain score of greater than or equal to 4 during the first operative day. Potential risk factors were included in the univariable and multivariable regression analyses to identify risk factors for developing moderate to severe pain. Results: 127 (41.5%) patients experienced moderate to severe postoperative pain on the first postoperative day. From multivariable analysis, positive pre-operative urine culture, operative time of more than 60 minutes, a stone procedure in the ureter, a postoperative stent, and ureter injury greater than grade I were related to moderate to severe pain with significance risk ratios (RR) of 2.99, 3.70, 4.87, 3.30, and 2.96, respectively (p < 0.05). Conclusion: Pain is a frequent postoperative problem associated with ureterscopic removal of stones and should be pro-actively treated with care. Patients are at a higher risk of moderate to severe pain if they required the ureteral procedure, had prolonged operative time, ureter injury after the procedure, needed a stent postoperatively, or had a history of positive preoperative urine culture.