Postoperative pain factors after ureterscopic removal of stones in kidney and ureter


  • Suttipong Chawong Division of Urology, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand
  • Teetayut Tangpaitoon Division of Urology, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand
  • Chatchawet Liwrotsap Division of Urology, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand



Pain, postoperative, ureterolithiasis, nephrolithiasis, ureterorenoscopy


Objective: Postoperative wpain after ureteroscopic removal of ureter and kidney stones frequently leads to re-hospitalization, revisit and increased cost. However, risk factors and incidence for early postoperative pain are still unclear. The aim of this study is to investigate the associated risk factors and the incidence of acute postoperative pain after ureteroscopic stone removal in the ureter and kidney.

Materials and Methods: Retrospective data from 306 consecutive patients who underwent ureteroscopic treatment for ureteral and kidney stones from January 2016 to December 2020 were collected. The patients were divided into two groups: (i) Mild postoperative pain (n = 179), defined as a pain score lower than four on the visual analog pain scale during the first operative day, and (ii) Moderate to severe postoperative pain (n = 127) was defined as a pain score of greater than or equal to 4 during the first operative day. Potential risk factors were included in the univariable and multivariable regression analyses to identify risk factors for developing moderate to severe pain.

Results: 127 (41.5%) patients experienced moderate to severe postoperative pain on the first postoperative day. From multivariable analysis, positive pre-operative urine culture, operative time of more than 60 minutes, a stone procedure in the ureter, a postoperative stent, and ureter injury greater than grade I were related to moderate to severe pain with significance risk ratios (RR) of 2.99, 3.70, 4.87, 3.30, and 2.96, respectively (p < 0.05).

Conclusion: Pain is a frequent postoperative problem associated with ureterscopic removal of stones and should be pro-actively treated with care. Patients are at a higher risk of moderate to severe pain if they required the ureteral procedure, had prolonged operative time, ureter injury after the procedure, needed a stent postoperatively, or had a history of positive preoperative urine culture.


Alelign T, Petros B. Kidney Stone Disease: An Update on Current Concepts. Advances Urol 2018. 2018:3068365.

Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol 2016;69:475-82.

Ghosh A, Oliver R, Way C, White L, Somani BK. Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years. World Urol 2017;35:1757-64.

Salciccia S, Sciarra A, Pierella F, Leoncini PP, Vitullo P, Polese M, et al. Predictors of Hospitalization After Ureteroscopy Plus Elective Double-J Stent as an Outpatient Procedure. Urol Int 2019;102:167-74.

MacCraith E, O’Kelly J, Ryan J, Forde JC, Cheema I, McLornan L, et al. Predictors of emergency department attendance following ureterorenoscopy for urolithiasis. Ir J Med Sci 2020;189:1445-9.

Ahn ST, Kim JH, Park JY, Moon du G, Bae JH. Acute postoperative pain after ureteroscopic removal of stone: incidence and risk factors. Korean J Urol 2012;53:34-9.

Oguz U, Sahin T, Senocak C, Ozyuvali E, Bozkurt OF, Resorlu B, et al. Factors associated with post-operative pain after retrograde intrarenal surgery for kidney stones. Turk J Urol 2017;43:303-8.

Luo Z, Jiao B, Zhao H, Huang T, Zhang G. Comparison of retrograde intrarenal surgery under regional versus general anaesthesia: a systematic review and meta-analysis. Int J Surg (London, England) 2020;82:36-42.

Bonkat G, Bartoletti RR, Bruyere F, Cai T, Geerlings SE, Koves B, et al. EAU Guidelines on Urological Infections. EAU [Internet]. 2019 [cited 2021 Jan 15]. Avaliable from: fections-2019.pdf

Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013;189:580-4.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373-9.

Geraghty R, Abourmarzouk O, Rai B, Biyani CS, Rukin NJ, Somani BK. Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era. Cur Urol Rep 2015;16:54.

Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Post-operative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Anal 2003;97:534-40.

Carr E. Exploring the Effect of Postoperative Pain on Patient Outcomes Following Surgery. Acute Pain 2000;3:183-93.

Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Anal 2002;95:627-34.

Sun K, Liu D, Chen J, Yu S, Bai Y, Chen C, et al. Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: A retrospective study. Sci Rep 2020;10:795.

Wang H, Li S, Liang N, Liu W, Liu H, Liu H. Post-operative pain experiences in Chinese adult patients after thoracotomy and video-assisted thoracic surgery. J Clin Nurs 2017;26:2744-54.

Travaglini F, Bartoletti R, Gacci M, Rizzo M. Pathophysiology of reno-ureteral colic. Urol Int 2004;72:20-3.

Cakici MC, Sari S, Selmi V, Sandikci F, Karakoyunlu N, Ozok U. Is the Efficacy and Safety of Retrograde Flexible Ureteroscopy in the Elderly Population Different from Non-elderly Adults? Cureus 2019; 11:e4852.

Assimos D, Crisci A, Culkin D, Xue W, Roelofs A, Duvdevani M, et al. Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study. BJU Int 2016;117:648-54.

Du K, Wang RS, Vetter J, Paradis AG, Figenshau RS, Venkatesh R, et al. Unplanned 30-Day Encounters After Ureterorenoscopy for Urolithiasis. J Endourol 2018;32:1100-7.

Sahan M, Sarilar O, Akbulut MF, Demir E, Savun M, Sen O, et al. Flexible ureterorenoscopy and laser lithotripsy with regional anesthesia vs general anesthesia: A prospective randomized study. Int Braz J Urol 2020;46:1010-8.

Djaladat H, Tajik P, Payandemehr P, Alehashemi S. Ureteral catheterization in uncomplicated uretero- lithotripsy: a randomized, controlled trial. Eur Urol 2007;52:836-41.

Cheung MC, Lee F, Leung YL, Wong BB, Chu SM, Tam PC. Outpatient ureteroscopy: predictive factors for postoperative events. Urology 2001;58:914-8.

Hollenbeck BK, Schuster TG, Seifman BD, Faerber GJ, Wolf JS, Jr. Identifying patients who are suitable for stentless ureteroscopy following treatment of urolithiasis. J Urol 2003;170:103-6.

Gunlusoy B, Degirmenci T, Arslan M, Kozacioglu Z, Nergiz N, Minareci S, et al. Bilateral single-session ureteroscopy with pneumatic lithotripsy for bilateral ureter stones: feasible and safe. Urol Int 2008;81:202-5.

Nestler S, Witte B, Schilchegger L, Jones J. Size does matter: ureteral stents with a smaller diameter show advantages regarding urinary symptoms, pain levels and general health. World J Urol 2020;38:1059-63.

El-Faqih SR, Shamsuddin AB, Chakrabarti A, Atassi R, Kardar AH, Osman MK, et al. Polyurethane Internal Ureteral Stents in Treatment of Stone Patients: Morbidity Related to Indwelling Times. J Urol 1991;146:1487-91.

Segalen T, Lebdai S, Panayotopoulos P, Culty T, Brassart E, Riou J, et al. Double J stenting evaluation after ureteroscopy for urolithiasis. Progress Urol 2019;29:589-95.

Netsch C, Knipper AS, Orywal AK, Tiburtius C, Gross AJ. Impact of surgical experience on stone- free rates of ureteroscopy for single urinary calculi of the upper urinary tract: a matched-paired analysis of 600 patients. J Endourol 2015;29:78-83.




How to Cite

Chawong, S., Tangpaitoon, T., & Liwrotsap, C. (2022). Postoperative pain factors after ureterscopic removal of stones in kidney and ureter. Insight Urology, 43(2), 119–27.



Original article