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Ziemba JB, Jones A, Lin G, Stambakio H, Tasian GE, Huang J. Postoperative Recovery of Quality-of-Life Following Ureteroscopy for Nephrolithiasis: The Impact on Pain Intensity and Interference and the Ability to Participate in Social Roles. Urology 2024; 188:38-45. [PMID: 38508532 DOI: 10.1016/j.urology.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To prospectively capture patient-reported outcomes to assess the recovery profile of ureteroscopy (URS). MATERIALS AND METHODS Adults undergoing URS for renal/ureteral stones were eligible for inclusion (11/2020-8/2022). Patients prospectively completed PROMIS - Pain Intensity, - Pain Interference, and - Ability to participate in social roles and activities in-person preoperatively (POD 0) and via email on POD 1, 7, 14, and 30. Scores are reported as T-scores (normalized to U.S. population, mean=50) with a change of 5 (0.5 SD) considered clinically significant. RESULTS One hundred and seventy-eight participants enrolled at POD 0 (POD 1 =87, POD 7 =83, POD 14 =70, POD30 =67). There was a worsening of quality of life from day 0 to day 1 and day 0 to 7. All dimensions then improved with an increase in scores from day 0 to day 14 and day 0 to day 30. On multivariable analysis, the presence of a preoperative ureteral stent (OR 0.14) and use of semirigid URS (OR 0.33) were associated with a reduced odds for severe pain interference at day 1. The use of semirigid URS (OR 0.20) was associated with a reduced odds for severe worsening in the ability to participate in social roles at day 1. CONCLUSION Ability to participate in social roles declines immediately postoperatively, while pain intensity and interference sharply increase. There is a gradual improvement until POD 30. Findings suggest preoperative stents may influence postoperative recovery. Results offer meaningful insight to assist in counseling and setting expectation for patients postoperatively.
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Affiliation(s)
- Justin B Ziemba
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Amanda Jones
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Lin
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hanna Stambakio
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jing Huang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Strup S, Harris A. Editorial Comment on "Postoperative Recovery of Quality-of-Life Following Ureteroscopy for Nephrolithiasis: The Impact on Pain Intensity and Interference and the Ability to Participate in Social Roles". Urology 2024; 188:46. [PMID: 38697364 DOI: 10.1016/j.urology.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Sydney Strup
- Department of Urology, University of Kentucky, Lexington, KY
| | - Andrew Harris
- Department of Urology, University of Kentucky, Lexington, KY; Veterans Affairs Medical Center, Lexington, KY.
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Becker REN, DiBianco JM, Higgins AM, Konheim J, Kleer E, Leavitt D, King A, Kachroo N, Majdalany SE, Gandham D, Fernandez Moncaleano G, Conrado B, Shoemaker E, Daignault-Newton S, Dauw CA, Ghani KR. Daily Ecological Momentary Assessments of Pain and Ability to Work After Ureteroscopy and Stenting. J Endourol 2024; 38:545-551. [PMID: 38545762 DOI: 10.1089/end.2023.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Introduction: Ureteral stents can cause significant patient discomfort, yet the temporal dynamics and impact on activities remain poorly characterized. We employed an automated tool to collect daily ecological momentary assessments (EMAs) regarding pain and the ability to work following ureteroscopy with stenting. Our aims were to assess feasibility and better characterize the postoperative patient experience. Materials and Methods: As an exploratory endpoint within an ongoing clinical trial, patients undergoing ureteroscopy with stenting were asked to complete daily EMAs for 10 days postoperatively or until the stent was removed. Questionnaires were distributed through text messages and included a pain scale (0-10) and a single item from the validated Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities instrument, as well as days missed from work or school. Results: Among the first 65 trial participants, 59 completed at least 1 EMA (overall response rate 91%). Response rates were >85% for each time point through postoperative day (POD)10. Median respondent age was 58 years (interquartile range [IQR] 50-67), and 56% were female. Stones were 54% renal and 46% ureteral, with a median diameter of 9 mm (IQR 7-10). Median stent dwell time was 7 days (IQR 6-8). Pain scores were highest on POD1 (median score 4) and declined on each subsequent day, reaching a median score of 2 on POD5. Sixty-three percent of patients on POD1 reported that they had trouble performing their usual work at least sometimes, but by POD5, this was <50% of patients. Patients who work or attend school reported a median of 1 day missed (IQR 0-2). Conclusions: An automated daily EMA system for capturing patient-reported outcomes was demonstrated to be feasible with sustained excellent engagement. Patients with stents reported the worst pain and interference with work on POD1, with steady improvements thereafter, and by POD5, the majority of patients had minimal pain or trouble performing their usual work. This work is associated with a registered clinical trial [NCT05026710].
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Affiliation(s)
| | | | - Andrew M Higgins
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeremy Konheim
- Department of Urology, Trinity Health IHA Medical Group, Ypsilanti, Michigan, USA
| | - Eduardo Kleer
- Department of Urology, Trinity Health IHA Medical Group, Ypsilanti, Michigan, USA
| | - David Leavitt
- Department of Urology, Henry Ford Health System, Detroit, Michigan, USA
| | - Andre King
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Naveen Kachroo
- Department of Urology, Henry Ford Health System, Detroit, Michigan, USA
| | - Sami E Majdalany
- Department of Urology, Henry Ford Health System, Detroit, Michigan, USA
| | - David Gandham
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Bronson Conrado
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elaina Shoemaker
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Casey A Dauw
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Cabo JJS, Miller NL. Nonopioid Pain Management Pathways for Stone Disease. J Endourol 2024; 38:108-120. [PMID: 38009214 DOI: 10.1089/end.2023.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Introduction: New opioid dependency after urologic surgery is a serious adverse outcome that is well-described in the literature. Patients with stone disease often require multiple procedures because of recurrence of disease and hence are at greater risk for repeat opioid exposures. Despite this, opioid prescribing after urologic surgery remains highly variable and in an emergency setting, opioids are still used commonly in management of acute renal colic. Methods: Two literature searches were performed using PubMed. First, we searched available literature concerning opioid-sparing pathways in acute renal colic. Second, we searched available literature for opioid-sparing pathways in ureteroscopy and percutaneous nephrolithotomy (PCNL). Abstracts were reviewed for inclusion in our narrative review. Results: In the setting of acute renal colic, multiple randomized control trials have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) attain greater reduction in pain scores, decreased need for rescue medications, and decreased vomiting events in comparison with opioids. NSAIDs also form a core component in management of postureteroscopy pain and have been demonstrated in randomized trials to have equivalent to improved pain control outcomes compared with opioids. Multiple opioid-free pathways have been described for postureteroscopy analgesia with need for rescue narcotics falling under 20% in most studies, including in patients with ureteral stents. Enhanced Recovery After Surgery protocols after percutaneous nephrolithotomy are less well described but have yielded a reduction in postoperative opioid requirements. Conclusions: In select patients, both acute renal colic and after kidney stone surgery, adequate pain management can usually be obtained with minimal or no opioid medication. NSAIDs form the core of most described opioid-sparing pathways for both ureteroscopy and PCNL, with the contribution of other components to postoperative pain outcomes limited because of lack of head-to-head comparisons. However, medications aimed specifically at targeting stent-related discomfort form a key component of most multimodal postsurgical pain management pathways. Further investigation is needed to develop pathways in patients unable to tolerate NSAIDs.
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Affiliation(s)
- Jackson J S Cabo
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicole L Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lee D, Agarwal A, Ali Z, Xiong R, Spencer E, Hemmons J, Lacko H, Delgado MK. Real-Time Measurement of Patient Reported Outcomes and Opioid Use Following Urologic Procedures using Automated Text Messaging. Urology 2022; 170:83-90. [PMID: 36115429 DOI: 10.1016/j.urology.2022.07.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate opioid consumption and patient-reported pain intensity following urologic procedures. METHODS Adult patients were consented following a urologic procedure, and data was collected through post-operative day 28 in a large tertiary care academic health system. An automated text messaging platform was used to collect patient reported pain intensity, ability to manage pain, and opioid use measured in oxycodone 5 mg tablet equivalents. Outcomes were weighted based on the inverse probability of response to yield representative estimates. RESULTS 1015 (51.8%) patients responded to the text-message survey. The median number of pills prescribed was 10 (IQR 6-10), and the median number of pills taken was 2 (IQR 0-6). By postoperative day 7, the median tablets taken overall was 0. Over the study period, 60.1% (6566) of all tablets prescribed were left unused, and 38.4% of patients did not use any of the prescribed opioids. Across urologic procedures, 6 tablets would accommodate the 75th percentile of patient-reported use, with the exception of major open procedures. CONCLUSIONS In this study utilizing real-time measurement of opioid use and pain levels with text messaging, there was evidence of dramatic over-prescription of opioids relative to use and pain levels. Patient-reported data, collected via text messaging, can support clinicians and policy leaders in forming national guidelines on evidence-based best practices, personalizing prescriptions and guide shared decision making to decrease opioid excess.
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Affiliation(s)
- Daniel Lee
- Division of Urology, University of Pennsylvania Health System, Philadelphia, PA; Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Anish Agarwal
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA; Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA
| | - Zarina Ali
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | - Ruiying Xiong
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Evan Spencer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica Hemmons
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hannah Lacko
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Mucio K Delgado
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA; Department of Emergency Medicine, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Sperling CD, Chelluri R, Dobbs RW, Talwar R, Lin G, Stambakio H, Ziemba JB. Longitudinal Changes in Quality of Life after Ureteroscopy for Nephrolithiasis. Urology 2022; 170:60-65. [DOI: 10.1016/j.urology.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
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Bevill MD, Schubbe ME, Flynn KJ, Said MA, Ten Eyck P, Tracy CR. PROSPECTIVE COMPARISON OF OPIOID VERSUS NON-OPIOID PAIN REGIMEN AFTER URETEROSCOPY. J Endourol 2022; 36:734-739. [DOI: 10.1089/end.2021.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mark D Bevill
- University of Iowa, Urology, Iowa City, Iowa, United States
| | | | - Kevin J. Flynn
- University of Iowa, Urology, Iowa City, Iowa, United States
| | | | - Patrick Ten Eyck
- University of Iowa, Biostatistics, Iowa City, Iowa, United States
| | - Chad Robert Tracy
- University of Iowa, Urology, 200 Hawkins Dr., 3 RCP, Iowa City, Iowa, United States, 52242-1089, ,
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Hale GR, Shahait M, Lee DI, Lee DJ, Dobbs RW. Measuring Quality of Life Following Robot-Assisted Radical Prostatectomy. Patient Prefer Adherence 2021; 15:1373-1382. [PMID: 34188454 PMCID: PMC8236265 DOI: 10.2147/ppa.s271447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) represents the most common solid organ malignancy in men. Fortunately, at the time of diagnosis, the majority of cases are staged as localized or regional disease, conferring excellent 5- and 10-year cure rates. There are several first line treatment options including surgical approaches such as robot-assisted radical prostatectomy (RARP) and radiation therapy (RT) available to patients with localized disease that offer similar PCa oncologic outcomes but are associated with potentially significant side effects which may impact health-related quality of life (HRQOL) domains. Recently, clinicians and investigators have sought to better understand these changes in HRQOL metrics with the utilization of patient-reported outcomes (PRO). Given that RARP represents the most common surgical treatment for PCa in the United States, there has been a particular interest in assessing these outcomes derived by patient perspectives to more fully appreciate treatment-related impact on quality of life following RARP. OBJECTIVE This narrative review sought to explore the instruments available to measure quality of life after RARP, a review of the PRO data after RARP, and future directions for assessing and improving quality of life outcomes following this surgery. CLINICAL USE There are several treatment options for men diagnosed with local and regional prostate cancer with similar oncologic outcomes but differing patterns of side effects affecting post-treatment quality of life. Understanding data reported directly by patients following RARP about their side effects and quality of life gives providers additional information for appropriate preoperative counseling for patients choosing between treatment options for their prostate cancer.
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Affiliation(s)
- Graham R Hale
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Mohammed Shahait
- Department of Urology, King Hussein Cancer Foundation and Center, Amman, Jordan
| | - David I Lee
- Department of Urology, University of California at Irvine, Irvine, CA, USA
| | - Daniel J Lee
- Division of Urology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan W Dobbs
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
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