Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones

Abstract

Objective: We aimed to investigate factors related to early postoperative pain after retrograde intrarenal surgery (RIRS). Material and methods:A prospective data analysis of 250 patients who underwent RIRS due to kidney stones was performed. Postoperative pain was evaluated in all patients by using visual analogue scale (VAS). Patients with severe pain (VAS score ≥7) were separated and included in Group I (n=46). While patients without pain or with insignificant pain were included in Group II (n=204). The impact of patient-related (age, gender, renal anomalies, shock wave lithotripsy history, preoperative hydronephrosis) stone-related (stone number, side, size, location and opacity) and operation-related (preoperative and postoperative ureteral Jstenting, ureteral injury, postoperative bleeding and fever, stone-free rates, size of access sheath, and sheath indwelling time) factors on early stage postoperative pain (if any) were investigated.Results: Female gender increased the risk for pain 3.6-fold (p<0.05). One millimeter increase in stone diameter increased the risk for postoperative pain 1.15-fold. Prolonged sheath time was another important factor which increased the risk for pain (p<0.05). Patients with high residual fragments were also prone to early postoperative pain. Conclusion:According to our results, patient-, stone-and operation-related factors associated with postoperative pain after RIRS were female gender, stone size and sheath time.

Controversies associated with ureteral access sheath placement during ureteroscopy

“…Interestingly, a prospective study which included 250 patients undergoing ureteroscopy for stone treatment, demonstrated that the only intraoperative factor which significantly affected immediate post-operative pain was the duration of use of UAS [ 22 ].…”

Systematic review of ureteral access sheaths: facts and myths

“…The only operation‐related factor that correlated with severe pain was the total time the UAS was placed: 46.57 (15–110) min with severe pain vs 41.54 (15–140) min in patients without pain. The size of the UAS, operation time, ureteral injury and pre‐ or postoperative stenting were not associated with post‐URS pain . In contrast, in an older prospective study, Kourambas et al found no difference in postoperative pain whether a UAS was used or not.…”

Minimally Invasive Surgery for the Treatment of Ureteric Stones – State-of-the-Art Review

“… 32 Prolonged duration of UAS time may be associated with greater post-operative pain. 33 Selection of optimal size and length of UAS is dependent on the user, and often dictated by the compliance of the ureter. Its use is easier in pre-stented ureters and a shorter length (35cm) is generally preferred in females and paediatric patients, while a longer length (45cm) is preferred for male patients.…”