Item Level Analysis of Patient-Reported Outcomes After Ureteroscopy for Kidney Stones- Plan Your Chores, Cancel Your Plans.

OBJECTIVE: To examine item level changes in PROMIS pain interference and ability to participate in social roles and activities following ureteroscopy (URS). MATERIALS AND METHODS: A prospective cohort study was conducted at a single academic center from 2020-2022. Adults undergoing URS for nephrolithiasis completed PROMIS pain interference (computer-adaptive test, 15 subdomains) and ability to participate in social roles and activities (short-form 8a, 8 subdomains) at baseline and at postoperative days (POD) 1, 7, 14, and 30. The primary outcome was a minimal clinically important difference (MCID, ≥5 points) in T-score from baseline to POD 1. Pairwise comparisons were assessed for change from baseline to each POD using linear mixed-effects models. RESULTS: A total of 178 participants were enrolled. For pain interference, only 2 of 15 items - work around the home and day-to-day activities - demonstrated a statistically and clinically significant worsening at POD 1 (change +5.9 and +5.7, respectively; both p<0.01), persisting through POD 7 before recovering by POD 30. In contrast, 6 of 8 social participation items worsened significantly at POD 1 (change -5.2 to -6.8 points; all p<0.01), with full recovery by POD 30. CONCLUSIONS: URS produces a specific, task-limited impact on pain interference but a comprehensive reduction in social participation both in and outside the home. These item-level findings offer actionable targets for patient counseling and anticipatory guidance prior to surgery.