Abstract: PD16-08
Sources of Funding: None

Introduction

While well recognized that ureteral stents cause significant postoperative discomfort, implications of their impact on quality of life have not been fully evaluated. In particular, it is unknown whether prior stent experience affects subsequent treatment decisions. We previously developed and validated a survey to assess the effect of prior experience on willingness to undergo future stone therapy in general, and willingness to accept higher postoperative risks in order to forgo stent placement in particular.

Methods

The survey assessing the impact of decreased quality of life on subsequent treatment decisions was distributed to patients with a history of ureteral stent at three geographically disparate academic centers between July and October 2016. Responses were encoded in duplicate to ensure accuracy. Statistical analysis was performed using Chi square analyses.

Results

A total of 131 surveys were completed. Assessing prior stent experience, those reporting more pain with the stent were less likely to accept surgery for an asymptomatic stone (p=0.001). See Figure 1. When informed that ureteroscopy with stent omission would have a small increased risk of unplanned return visit compared with ureteroscopy with a stent, 24% chose surgery without a stent. However, of those reporting worse pain with the stent than the stone, 40% of respondents were willing to forgo stent. Conversely, of those that reported worse pain with the stone, only 11% chose surgery without a stent (p=0.004). When assessing impact of quality of life changes, only decreased interest in socializing (p=0.019) and decreased appetite (p=0.010) were associated with a higher likelihood to choose stent omission. Other consequences of stent placement (e.g. missed work, inability to care for family, exercising less, and decrease sexual activity) were not associated with a higher likelihood of choosing surgery without a stent.

Conclusions

Patients experiencing more pain with their stent than the inciting stone are less willing to treat asymptomatic renal stones and are more willing to accept greater postoperative risk in order to forgo future ureteral stents. With increased emphasis on shared medical decision making, an enhanced understanding of factors affecting these decisions is important in order to appropriately counsel patients.

Funding

None