Evaluating Postoperative Pain After Ureterorenoscopy.

After a ureteroscopy (URS) for the removal of ureteral stones, a double-J stent is routinely placed. Among other measures, this is intended to prevent pain caused by ureteral swelling, small residual fragments, blood clots, and potential drainage obstructions, which could lead to colic or fever. However, the evidence supporting the benefit of this practice is limited. At the same time, many patients report discomfort due to the stent (e.g., flank pain, dysuria, frequent urination, hematuria), which can significantly impact their quality of life.

• No Double-J catheter insertion (Other): Ureterorenoscopy without consecutive DJ-stent insertion.
• Double-J catheter (Procedure): Transurethral catheter insertion

Primary outcomes

• Postoperative pain assessment [up to 4 weeks postoperative]: Assessment of postoperative pain will be conducted using the Visual Analogue Scale (VAS) and the study-specific mobile application HEATMAP (Byldr GmbH, Switzerland). The primary outcome is the difference between the pain scores recorded by the VAS and those recorded by the HEATMAP application at predefined postoperative time points \[both measured on a scale from 1-10, with higher scores indicating greater pain\].

Secondary outcomes

• Length of stay [days] [During the hospital stay, on average 2 days]: Time from surgery to discharge in days \[d\]
• Pain Assessment [pre-/peri-/postoperative]: Assessment of pain level via Visual Analogue Scale (VAS), scale \[1-10, higher scores indicates greater pain\]
• Pain Management [pre-/peri-/postoperative]: Documentation of pain management \[according to the WHO Analgesic Ladder, 1-4, higher scores mean more intense pain treatment\]
• Secondary need of double-J catheter [up to 4 weeks postoperative]: (Please note, this applies only for patients that where in the intervention group.) Patient received a double-J catheter, binary \[yes/no\]
• Procedure related readmissions [up to 4 weeks postoperative]: Readmission that can be linked to the URS, binary \[Yes/No\]
• Procedure related reoperations [up to 4 weeks postoperative]: Reoperation that can be linked to the URS, binary \[Yes/No\]
• Comprehensive Complication Index [up to 4 weeks postoperative]: Any complication that occurred within 30 days post surgery, Scale \[from 0 (no complication) to 100 (death)\]

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age 18 years or older
* Patients with ureteral stones scheduled for ureteroscopy (URS) and stone removal
* Previous pre-stenting
* Informed Consent as documented

Exclusion Criteria:

* Complex ureteral conditions (e.g., known ureteral strictures)
* Impacted stones
* Solitary kidney
* Patients with significant renal stones (>3mm)
* Previous ureteral surgeries (except endoscopic stone treatments)
* Pregnancy or suspected pregnancy

• Lukas John Hefermehl, PD Dr. med., Principal investigator, Kantonsspital Baden AG

NIH grants: 2025