<p><strong>BACKGROUND: </strong>Our objective was to describe day-to-day evolution and variations in patient-reported stent-associated symptoms (SAS) in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS), a prospective multicenter observational cohort study, using multiple instruments with conceptual overlap in various domains.</p>

<p><strong>METHODS: </strong>In a nested cohort of the STENTS study, the initial 40 participants having unilateral ureteroscopy (URS) and stent placement underwent daily assessment of self-reported measures using the Brief Pain Inventory short form, Patient-Reported Outcome Measurement Information System measures for pain severity and pain interference, the Urinary Score of the Ureteral Stent Symptom Questionnaire, and Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index. Pain intensity, pain interference, urinary symptoms, and bother were obtained preoperatively, daily until stent removal, and at postoperative day (POD) 30.</p>

<p><strong>RESULTS: </strong>The median age was 44&nbsp;years (IQR 29,58), and 53% were female. The size of the dominant stone was 7.5&nbsp;mm (IQR 5,11), and 50% were located in the kidney. There was consistency among instruments assessing similar concepts. Pain intensity and urinary symptoms increased from baseline to POD 1 with apparent peaks in the first 2&nbsp;days, remained elevated with stent in situ, and varied widely among individuals. Interference due to pain, and bother due to urinary symptoms, likewise demonstrated high individual variability.</p>

<p><strong>CONCLUSIONS: </strong>This first study investigating daily SAS allows for a more in-depth look at the lived experience after URS and the impact on quality of life. Different instruments measuring pain intensity, pain interference, and urinary symptoms produced consistent assessments of patients' experiences. The overall daily stability of pain and urinary symptoms after URS was also marked by high patient-level variation, suggesting an opportunity to identify characteristics associated with severe SAS after URS.</p>

<p><strong>OBJECTIVE: </strong>To better understand the degree and time to resolution of pain in the post-operative period, we captured patient-reported pain&nbsp;intensity and interference prospectively in&nbsp;patients following ureteroscopy for nephrolithiasis.</p>

<p><strong>MATERIALS AND METHODS: </strong>Adults undergoing ureteroscopy for renal/ureteral stones from 11/2018 to 1/2020 were eligible for inclusion. All received non-opioid postoperative pain control. Patients prospectively completed PROMIS-Pain Intensity and PROMIS-Pain Interference instruments pre-operatively on POD 0 and via email on POD 1, 7, and 14. Scores are reported as T-scores (normalized to US population, mean=50) with changes of 5 (0.5 SD) considered clinically significant.</p>

<p><strong>RESULTS: </strong>126 patients completed enrollment at POD 0 (POD 1=74, POD 7=61, POD 14=47). Compared to US means, intensity and interference were significantly different at all time point comparisons (Wilcoxon rank test; all p&lt;0.001) except intensity at POD 7 (p=0.09) and interference at POD 14 (p=0.12). For both, there was a significant difference at each time comparison (repeated measures ANOVA; all p &lt;0.05). Increasing age was predictive of lower intensity (CI: -0.31- -0.04; p=0.012) and interference (CI: -0.36 - -0.06; p=0.01) at POD 1. The presence of a post-operative stent was predictive of higher intensity (CI: 0.68-10.81; p=0.03) and interference (CI: 0.61-12.96; p=0.03) at POD 7. Increasing age remained a predictor of lower interference at POD 1 on multivariable analysis (CI: -0.46 - -0.01; p=0.03).</p>

<p><strong>CONCLUSIONS: </strong>Pain intensity and interference are elevated immediately, but intensity normalizes by POD 7, while interference remains elevated until POD 14. Age and indwelling ureteral stent influence both intensity and interference.</p>

<p><em>US News &amp; World Report (USNWR)</em> rankings can assist patients with choosing where to receive their specialty care. <em>USNWR </em>methodology assumes that the specialty caring for hospitalized patients is equivalent to the specialty assigned by administrative coding. We examined the frequency of discordance between <em>USNWR </em>methodology-assigned specialty and the actual specialty care received for 2 surgical specialties, otolaryngology (ENT) and urology (GU). Our analysis included inpatient deaths identified by <em>USNWR </em>coding for these specialties from 2013 to 2017 at a single academic tertiary care center. We found that a minority of patients with deaths attributed by&nbsp;<em>USNWR</em>&nbsp;to these 2 specialties were actually cared for by ENT (6/14; 43%) or GU (3/19; 16%). Only 5 of 14 (36%) and 2 of 19 (11%) deaths were potentially associated with ENT and GU care, respectively. We identified a significant discordance between <em>USNWR</em>-assigned specialty and the actual specialty care received.</p>

<p><strong>PURPOSE: </strong>Professional associations recommend ultrasound as the initial imaging study in children with suspected nephrolithiasis but computerized tomography remains frequently used. We identified patient and institutional characteristics associated with computerized tomography as the first imaging study in children with nephrolithiasis diagnosed in the emergency department.</p>

<p><strong>MATERIALS AND METHODS: </strong>We performed a cross-sectional study of children 2 to 18 years old with nephrolithiasis who were referred to a freestanding pediatric hospital from 2003 to 2012. We identified the imaging modality first used to evaluate the child. Medical directors at the emergency department where children were first evaluated were sent a questionnaire to ascertain emergency department characteristics. Multivariate hierarchical logistic regression models were used to determine patient and institutional characteristics associated with initial computerized tomography.</p>

<p><strong>RESULTS: </strong>Of 536 eligible children 323 (60.2%) were evaluated at emergency departments from which surveys were returned. Of the 323 children 238 (71%) underwent computerized tomography as initial imaging. Ultrasound was available at all emergency departments. Older patient age was associated with higher initial computerized tomography use (OR 1.09, 95% CI 1.04-1.16). A more recent year of diagnosis (OR 0.80, 95% CI 0.72-0.88) and a clinical care pathway that used ultrasound as initial imaging (OR 0.29, 95% CI 0.01-0.38) were associated with lower initial computerized tomography use.</p>

<p><strong>CONCLUSIONS: </strong>A clinical care pathway in the emergency department was the only institutional characteristic associated with lower computerized tomography use. Future studies are needed to determine whether care pathways using ultrasound for initial imaging in children with suspected nephrolithiasis would decrease inappropriate computerized tomography and improve adherence to national guidelines.</p>