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• W2331444963 abstract "You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy1 Apr 2016PD31-05 TITLE: PAIN FOLLOWING URETERAL STENT REMOVAL: PREVALENCE AND TREATMENT Gabriel Belanger and Lisa Beaule Gabriel BelangerGabriel Belanger More articles by this author and Lisa BeauleLisa Beaule More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.549AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral stents may cause ureteral edema which can lead to ureteral obstruction after stent removal, with symptoms similar to ureteral colic. The prevalence of this phenomenon has not been characterized. Tadros et al (British Journal of Urology, 111 (1):101-5 (2013)) gave patients Rofecoxib 50 mg (withdrawn from the US market in 2004) or placebo prior to ureteral stent removal and noted a significant reduction in severe pain at 24 hours on the numeric pain rating scale, suggesting post-stent removal obstruction is commonplace. The effect was so pronounced, the study was terminated at interim analysis. As this amount of pain did not seem typical of our patients, we designed a study to assess pain after stent removal and whether prophylactic NSAID use would be a useful treatment. METHODS A prospective, randomized, double-blind, placebo-controlled trial was performed at our institution following IRB approval. Adults undergoing cystoscopy and stent removal after recent ureteroscopic treatment of nephrolithiasis were randomized to receive either 440 mg Naproxen sodium or placebo just prior to stent removal. Patients completed a visual analogue scale (VAS, 0-100 mm) for their pain level at time of stent removal and 24 hours later. The primary outcome was visual analogue scale at 24 hours. Data was analyzed using Chi-Square, Fischer’s exact, student’s t or Mann Whitney U tests as appropriate. RESULTS 151 participants were enrolled and randomized into the study. 31 participants did not return their 24 hour VAS and were excluded. There was no difference in age, sex, stent duration, largest stone size, stone location, stone number, or initial VAS between groups (all >0.05). 3 of 120 (2.5%) of participants had severe pain (VAS >70) at follow-up. Opiate use did not differ between groups (12.5% vs 7.8%, p=0.39), but patients who used opiates (n = 12) had higher 24 hour VAS scores that those who did not (mean 32.1 mm in those using opiates, 4.9 mm in those not using opiates p<0.001) and a greater decrease in VAS (p= 0.004). 24 hour VAS scores were significantly lower in the treatment group (median VAS, 3.3 mm versus 0 mm, p=0.04), but there was no difference between groups in the frequency of a change in VAS >20 (p=0.20) or of patients with severe pain (p=1.0). CONCLUSIONS Though there was a statistically significant difference in 24 hour VAS between groups, it does not appear to be clinically relevant. Significant pain after ureteral stent removal appears to be a rare phenomenon not requiring prophylactic pain medication. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e718-e719 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Gabriel Belanger More articles by this author Lisa Beaule More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2331444963 title "PD31-05 TITLE: PAIN FOLLOWING URETERAL STENT REMOVAL: PREVALENCE AND TREATMENT" @default.
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