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Ureteral Stent-Associated Pain: A Review.

PURPOSE
Ureteral stent-related pain is a well-known side effect of stent placement. To date, there is a paucity of resources that address this topic. Herein, we present theories on stent pain pathophysiology, summarize available pain outcome data for different stent designs, and provide an overview of the management of stent pain, including preplacement modifiers, medical management, and other considerations.


MATERIALS AND METHODS
This narrative review focused primarily on articles indexed in the PubMed(®), Google Scholar™, and EMBASE databases. No formal search strategy was used and no meta-analysis of data was performed.


RESULTS
Stent pain pathophysiology is multifactorial and likely a result of mucosal irritation along with retrograde reflux of urine. While there is a consensus on the lack of association between stent length, diameter, and stent-related flank pain, stents should be properly sized so as to prevent dislodgement. Insufficient data exist comparing stent materials and durometry. Multiple drug-eluting stents are in development and have demonstrated promising early results. Alpha-blockers have shown efficacious results and should be considered along with or in combination with anticholinergics and nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of ureteral stent-related symptoms, with judicious consideration of their side effect profiles. Periureteral botulinum toxin A injections are a promising, novel treatment modality.


CONCLUSIONS
Ureteral stent pain is common and multiple modalities have been studied and are in clinical use for its treatment. Care should be taken to avoid placement of stents if possible, with continual reassessment of indications to maintain stents in patients. Relative heterogeneity among studies and small sample sizes make creating specific evidence-based pain management recommendations challenging. Alpha-blockers, antimuscarinics, and NSAIDs are all generally well tolerated and effectively reduce symptoms, but patient-specific factors must be the paramount consideration when choosing monotherapy or combination therapy. Future studies are needed to better define ideal material characteristics and pharmacologic treatments.