Table 3.

Summary of the Psychological, Functional, and Interpersonal Effects of Post-Ureteroscopy Stents by the Interference Group

Domain	Participant interference group
	Minimal (n = 12)	Moderate (n = 19)	Substantial (n = 8)
Psychological
Sleep	Little to no impact on sleep quality When sleep was impacted, it was due to urinary frequency and not pain, and participants were easily able to get back to sleep after waking to urinate But other than that, there was no impact, and I was able to go right back to sleep. So, it didn't affect sleep other than urinary frequency.—Female, age 52	Impact on sleep was mixed About half of participants attributed some level of sleep disruption to the stent, most commonly related to urinary frequency The stent being in there caused me to urinate more often, which then I woke up more times in the night to urinate. I would wake up more tired in the morning, since I'd been woken up multiple times throughout the night.—Male, age 20	Significant impact on sleep Most participants noted substantial disruption in sleep patterns and sleep quality Quality of sleep was affected by urinary frequency and some pain Sleep was definitely not fun either. Like I said, I wasn't very comfortable, I couldn't stay asleep for very long at times.—Female, age 38
Mood	Little to no impact on mood Participants were able to maintain a positive outlook, with only brief periods of negative mood linked to pain Very little [effect on mood]. I mean at times I'd get aggravated, but it's about all of it. But, no, I think my mood was pretty consistently positive.—Female, age 58	Impact on mood was mixed Some participants had no impact on mood Some reported increases in negative mood as a result of both pain and restrictions on usual activity Participants tended to use words such as “cranky,” “irritable,” and “frustrated” to discuss their experience Sometimes I would be grouchy and sometimes I would just be very emotional. I just wanted to be better. I just wanted to feel better.—Female, age 25	Significant impact on mood Participants expressed anger at being in pain, as well as using stronger terms such as “depressed,” “anxious,” and “isolated” to describe their emotions I was in a real bad mood. I was irritated and angry.—Female, age 36
Overall enjoyment of life	Little to no impact on enjoyment of life Participants continued with their usual activities and recognized that the stent was a temporary inconvenience [Enjoyment of life] was barely impacted. The only impact was the annoyance of going to the bathroom. It was just annoying. So, as far as enjoyment of life, I could put up with a little bit of annoyance for a few days. That was not greatly impacted.—Female, age 52	Moderate or significant decrease in enjoyment of life Many activities were curtailed or uncomfortable for participants, mainly due to pain The stent was also mentally burdensome I would say [enjoyment of life] decreased a little bit just because of that mental expectation you have of all the things that you can go do, and obviously you think about things you want to do during those times that you're kind of missing out on … [it] definitely was not as enjoyable not being able to do the things that I would want to do or like to do.—Male, age 29	Significant decrease in enjoyment of life Both pain and urinary frequency adversely affected participants' ability to engage in and enjoy most activities Anticipatory anxiety about the impending experience of pain and urinary frequency further impacted enjoyment I would say that it greatly impacted. Just because like if you knew that somebody was going to stab you in the kidney every two hours, that's not a good life. So just from that point of view, just because like maybe the pain wasn't there the entire time, but the fact that I knew there was going to be pain, and it would be very, very bad, and it's going to happen pretty regularly just because of what I have to do, which is drink tons of water.—Male, age 40
Functional
Work	No stent-related disruptions in ability to work Yeah, I actually went back to work the next day.—Male, age 60	Moderate or significant impact on ability to work Participants tended to take some time off or worked part-time after the stent surgery, worked fewer hours than usual once they returned to work, and worked less effectively with the stent in place I took a couple days off for the surgery, and then I was able to go back. I worked a couple of hours at a time.—Female, age 19	Significant impact on ability to work Participants mostly did not work for the duration of the stent, primarily due to pain and/or pain medication Participants struggled with their ability to accomplish work-related tasks if they did resume working before stent removal I assumed that after a couple days on the couch – I took off a couple days of work and had a weekend – and I was like, “Oh, four days will be plenty. Five days will be plenty” and then I was like, “I'll go back to work.” And I would try to go back to work and I'd have to leave because the pain – like I said – the more I moved, the more uncomfortable I was.—Female, age 31
Exercise	Little to no impact on ability to exercise as usual I even went paint balling three days after that, and I was very active and everything was fine, fine. I didn't change one thing.—Male, age 45	Moderate or significant reduction in desire or ability to exercise Many participants did not bother to try exercising with the stent in place Those who did exercise resumed activity toward the end of the indwelling stent period and/or substituted less arduous exercises for more strenuous ones I mean, I didn't even attempt [exercise] because just with a little walking … and when I went to the store or tried to go out to eat, I mean, that would just drain me, so there's really no way I could engage in those activities.—Male, age 57	Significant reduction in ability to exercise, relative to participants' usual levels of physical activity; participants did not exercise at all while the stent was in place Pain kept many participants from both formal exercise and from other types of physical activity, such as walking I wasn't able to exercise. I wasn't able to even walk my dog. I wasn't really able to do anything around the house. I was kind of annoyed because I'm a pretty active person, so I thought for sure I'd feel fine.—Female, age 31
ADLs	Little to no impact on ability to perform ADLs, such as housework, cooking, and self-care A few participants described being more tired or moving more cautiously than usual, while still successfully carrying out these activities I was able to do those things. There wasn't any major issues. I just felt like I had to be more careful.—Male, age 33	Limited impact on ADLs for some Moderate limitations on ability to perform ADLs for others, due to both pain and fatigue Participants were unable to carry out daily activities for the first few days but returned to normal activity levels by the time of stent removal Participants also made trade-offs by prioritizing some tasks over others and allowing ample time to rest between tasks I set them aside, or I did them on maybe the third day, when I felt better. Or I'd have a few hours where I was feeling pretty good, and I'd bust out and do some cleaning or something like that, and then end up being so tired that I couldn't do making dinner or something like that. So, it was a tradeoff.—Male, age 54	Significant limitations on ability to carry out daily activities Pain kept participants from doing their usual activities, with most doing as little as possible Limitations on ADLs persisted for the duration of the time that the stent was in place I did the bare minimum that was required, like if I tried to take a shower, and stuff like that, and take out the trash, but I did the absolute minimum amount that I could.—Female, age 23
Driving	Little to no impact on ability to drive I still did the grocery store, and some of the shops I go to, and drove around.—Female, age 62	Moderate impact on ability to drive Many participants did not drive for the first few days after stent placement, found driving uncomfortable, and limited the number and length of trips for which they drove The only time I drove, I think it was twice. Once I went to get some groceries, and the other time I drove to the stent removal. So, out of those both times, it just wasn't comfortable at all. … I guess the bumps in the road made it more painful.—Male, age 39	Significant impact on ability to drive A combination of pain and pain medication kept these participants from driving Some also did not feel well enough to consider going anywhere and thus did not attempt to drive I couldn't sit up that straight to drive [because of the pain when I moved].—Female, age 67
Childcarea	Little to no impact on ability to care for children or grandchildren as usual The first day, like the first 24 hours, I avoided lifting them, and we were able to just kind of keep them at arm's length, but beyond that, no, absolutely not. I was back to all normal interactions with them.—Female, age 52	Moderate impact on ability to care for children Picking up children exacerbated pain and bleeding Participants sought help with childcare from others and/or modified the ways in which they interacted with children My husband actually had to stay home and help take care of the kids, because with getting sick and having to rush off to the bathroom and not being able to pick up my two-year-old, and all that kind of stuff. He had to stay home and help for a couple of days. … I want to say he took maybe three days off.—Female, age 25	Significant impact on childcare Participants significantly curtailed their interactions with children for the duration of the stent They also placed restrictions on how they interacted when they did see children or grandchildren I just stayed away. [I didn't have the grandkids over and didn't visit.] … I just felt like I was missing out on a lot.—Female, age 67
Interpersonal
Leisure/social activities	Little to no impact on ability to engage in leisure and/or social activities as usual …because I knew I always had to be kind of close to a restroom, I tried not to be out for too long, if I was out. But, overall, I was able to live my life pretty normally.—Male, age 33	Moderate or significant impact on desire or ability to participate in leisure and social activities Participants engaged in enjoyable activities on a more limited basis, took a hiatus for a few days before resuming leisure/social activities, or entirely curtailed these activities when the stent was in place Limitations were due to pain, urinary frequency, and other stent symptoms I didn't even want to play video games, that was a surprise. Okay, we got a week of video games, and I was like, “Nah. I don't really have that concentration level or something.” It's weird. … We had one of our friends from a local area over for dinner one night, and I just kind of said, “Hey, I'm low-action. I'm not going to be pretty vibrant today.” And that was about it. I hung out with very close friends, but not casual.—Male, age 54	Significant impact on leisure and social activities Participants almost completely disengaged from leisure and social activities and did very little for the duration of the indwelling stent Limitations were primarily due to pain and urinary frequency It also happened over [a holiday] weekend, so I just canceled a bunch of plans. … I didn't socialize. I really didn't leave the house. … I didn't hang out with my family. … I watched a lot of TV.—Female, age 42

^a The number of participants for which childcare was relevant was small.

ADLs = activities of daily living.