Complete intraureteral stent placement reduces stent-related pain in normotensive subjects and in diabetes: Subgroup analysis of a prospective randomized clinical trial

Purpose: Pain is a common symptom that is associated with ureteral stent placement, but its degree of perception might vary among individuals. Compared with conventional stent placement (C-SP), complete intraureteral stent placement (CIU-SP) has shown promise in reducing stent-associated pain. This study aimed to investigate the effect of patient characteristics and comorbidities on pain reduction after CIU-SP. Materials and methods: Patients who underwent ureteroscopic lithotripsy and stent placement were randomized into the CIU-SP and C-SP groups. Stent-associated symptoms were evaluated using the Ureteral Stent Symptom Questionnaire on day 7, immediately before stent removal. Stent-associated pain was determined by the answer to question P1 (yes or no). Subgroup analysis was conducted based on various patient characteristics and comorbidities. Results: Of the 103 randomized patients, 91 (45 in CIU-SP and 46 in C-SP) were included in the final analysis. Body pain was reported by 31 (68.9%) after CIU-SP and 41 (89.1%) after C-SP ( P = 0.021). Compared with C-SP, CIU-SP significantly reduced pain in the normotensive population (66.7% versus 93.7%, P = 0.006) but not in hypertensive individuals (77.8% versus 76.9%, P = 1.000). Conversely, compared with C-SP, CIU-SP was associated with less pain in patients with diabetes (37.5% versus 88.9%, P = 0.05) but not in patients without diabetes (75.7% versus 89.2%, P = 0.221). Age, sex, stone laterality, body mass index, and smoking status did not influence the reduction of pain after CIU-SP. Conclusion: Compared with C-SP, CIU-SP was effective in reducing stent-associated pain, especially in normotensive and diabetic populations. These findings align with existing literature, which emphasized the potential impact of hypertension on decreased pain perception and highlighted the known association between diabetes and bladder hypersensitivity.