The study is being completed to compare patient reported outcomes for stent omission vs. placement after using a ureteral access sheath for uncomplicated ureteroscopy. Participants that consent for the study will complete baseline PRO questionnaires. A UAS will be used during surgery, and the size left to the discretion of the surgeon. At the end of the procedure, the urologist will evaluate the ureter for iatrogenic injury, and the ureter will be graded using the Post Ureteroscopic Lesion Scale (PULS). Patients assessed with PULS 0 and PULS 1 will meet 2nd stage eligibility and will be randomized 1:1 to either stent omission or stent placement. When a stent is placed, the stent type and decision to leave a string (tether) will be at the operating urologist's discretion. Hypothesis: \- stent omission arm will be non-inferior to stent placement in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity, and have lower 30-day healthcare utilization.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
184
Surveys will be completed for each group at the following timeframes: baseline (pre-procedure, daily up to 7-10 days or until stent is removed (if placed), 30 days after the procedure. Additionally, participants medical records will reviewed for information.
University of Michigan
Ann Arbor, Michigan, United States
RECRUITINGDifferences in PROMIS Pain Interference
This is a 6-item survey which participants select a response for each item from 1=not at all to 5=very much for how much pain interfered with their life. The scores range from 6-30 with a higher score indicating greater interference.
Time frame: Baseline (before procedure), 7-10 days after procedure
Differences in PROMIS Pain intensity
This is a 3-item survey which participants select a response for each item from 1=no pain to 5=very severe for intensity of their pain. The scores range from 3-15 with a higher score indicating greater pain intensity.
Time frame: 7-10 days after procedure
Differences in PROMIS Pain intensity
This is a 3-item survey which participants select a response for each item from 1=no pain to 5=very severe for intensity of their pain. The scores range from 3-15 with a higher score indicating greater pain intensity.
Time frame: 4-6 weeks after procedure
Differences in Urinary Symptoms based on the Lower Urinary Tract Dysfunction Research Network (LURN) Symptom index (SI)-10
The LURN SI-10 (10-Item LURN Symptom Index) assesses urinary frequency, nocturia, urgency, incontinence, bladder pain, voiding and post-micturition symptoms. Responses for each item range from 0 to 4 or 0 to 3 and are then summed for total scores ranging from 0 to 38 (higher scores = worse symptoms/bother).
Time frame: 7-10 days after procedure
Differences in Urinary Symptoms based on the Lower Urinary Tract Dysfunction Research Network (LURN) Symptom index (SI)-10
The LURN SI-10 (10-Item LURN Symptom Index) assesses urinary frequency, nocturia, urgency, incontinence, bladder pain, voiding and post-micturition symptoms. Responses for each item range from 0 to 4 or 0 to 3 and are then summed for total scores ranging from 0 to 38 (higher scores = worse symptoms/bother).
Time frame: 4-6 weeks after procedure
Difference in PROMIS Social Roles & Activities
This is one question from the PROMIS that participants select from Never (5) to Always (1) whether there is trouble doing all of participant's usual work. A lower score indicates more trouble.
Time frame: Daily after procedure (10 days or up to stent removal)
Difference in Pain intensity assessment based on the Visual analog scale
Participants pain level is selected from 0-10 with a higher score indicating greater pain.
Time frame: Daily after procedure (10 days or up to stent removal)
Treatment Satisfaction based on the International Consultation on Incontinence Questionnaire Short Form (ICIQ-S)
This is a 6-item questionnaire that participants complete regarding the satisfaction with treatment. The range of scores for each question is between 0-5, with a range of score between 0-24 with a higher score indicating greater satisfaction.
Time frame: 7-10 days post procedure and 4 weeks
Count of days off work Patient
Time frame: Day 7 post procedure and 4 weeks post procedure
Count of days off work Caregiver
Time frame: Day 7 post procedure and 4 weeks post procedure
Composite healthcare utilization metric within 30 days (WinRatio)
WinRatio composite healthcare utilization score ranges from 1 to 6 based on each participants highest level of healthcare utilization, with higher score indicating a worse outcome: 6) Hospitalization and ICU care; 5) Unplanned hospitalization; 4) Additional OR or Interventional Radiology procedure 3) Emergency department visit; 2) Ambulatory encounter: clinic visit or diagnostic outpatient testing; 1) Ambulatory encounter: phone call or electronic medical record.
Time frame: Up to 30 days after procedure
Abnormal imaging findings within 60 days
Urological imaging performed within 60 days per surgeon or patient preference.
Time frame: within 60 days of procedure
Stone-free rates within 60 days
X-ray, Ultrasound, computerized tomography (CT) scan, or any combination
Time frame: within 60 days of procedure
Differences in PROMIS Pain Interference
This is a 6-item survey which participants select a response for each item from 1=not at all to 5=very much for how much pain interfered with their life. The scores range from 6-30 with a higher score indicating greater interference.
Time frame: 4-6 weeks after procedure
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