完全輸尿管內支架置入可減少血壓正常患者和糖尿病患者與支架相關的疼痛：前瞻性隨機臨床試驗的亞組分析

徐宏仁¹、李秉叡¹、何承勳^1;2

¹新光吳火獅紀念醫院 外科部 泌尿科；²天主教輔仁大學 醫學系 醫學院

Complete Intraureteral Stent Placement Reduces Stent-Related Pain in Normotensive Subjects and in Diabetes: Subgroup Analysis of a Prospective Randomized Clinical Trial

Hung-Jen, Hsu¹、Ping Jui, Lee¹、Chen-Hsun Ho^1,2

¹ Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

² School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan

Purpose: Pain is a common symptom associated with the placement of a ureteral stent. On the other hand, the perception of pain might vary in degree across individuals. Complete intraureteral stent placement (CIU-SP) has been shown to cause less stent-associated pain as compared to conventional stent placement (C-SP). The current study aimed to investigate whether this effect of pain reduction is affected by patients’ characteristics and comorbidities.

Materials and Methods: Patients who underwent ureteroscopic lithotripsy and stent placement were randomized into two groups: CIU-SP and C-SP. Stent-associated symptoms were evaluated with the Ureteral Stent Symptom Questionnaire (USSQ) at day 7 (right before the stent was removed). The question P1 assessed if the subjects suffered from stent-associated pain (yes or no). Subgroup analysis was performed on various patients’ characteristics and comorbidities.

Results: We randomized 103 patients, of which 91 (45 in CIU-SP and 46 in C-SP) entered the final analysis. Thirty-one (68.9%) in the CIU-SP versus 41 (89.1%) in the C-SP group reported body pain (P=0.021). CIU-SP significantly leads to less pain than C-SP in the normotensive population (66.7% vs 93.7%, P=0.006), but not in the hypertensive population (77.8% vs 76.9%, P=1.000). On the other hand, CIU-SP was associated with less pain than C-SP in the diabetes (37.5% vs 88.9%, P=0.05), but not in the non-diabetes (75.7% vs 89.2%, P=0.221). Age, gender, stone laterality, BMI, and smoking status did not affect the effect of CIU-SP versus C-SP.

Conclusions: CIU-SP leads to less stent-associated pain as compared to C-SP. The effect is observed in the normotensive, but not the hypertensive population; it is also observed in the diabetes, but not in the non-diabetes. These findings are supported by literature. First, previous studies have demonstrated that hypertension is associated with reduced perception of pain. Second, it is well known that diabetes is associated with bladder hypersensitivity.