Perioperative trajectories and predictors of parental and child anxiety in pediatric ureterorenoscopy for urolithiasis: A prospective multi-time-point study.

OBJECTIVE: Pediatric kidney stone disease is a health problem that may require invasive surgical interventions during childhood and can impose a substantial psychological burden on both the child and the family. Uncertainty regarding anesthesia, perioperative safety, postoperative pain, and early recovery/stone clearance may increase both parental and child anxiety. This study assessed perioperative anxiety in children undergoing kidney stone surgery and their parents, and identified demographic and clinical factors associated with anxiety.

MATERIALS AND METHODS: This prospective observational study was conducted at a tertiary academic urology center between January and July 2025. The study population consisted of 100 children aged 3-18 years scheduled to undergo ureterorenoscopy (URS) for kidney stones, along with their parents. Anxiety levels of the children were assessed using the Facial Image Scale (FIS), whereas parental anxiety was assessed using the State-Trait Anxiety Inventory, including state (STAI-S) and trait (STAI-T) components. The scales were administered before surgery and at postoperative 1., 2., and 6. h. Data were analyzed using descriptive statistics, analysis of variance, and linear regression methods.

RESULTS: The median age of the children included in the study was 7.5 years, and the mean duration of surgery was 44.39 ± 14.60 min. There was no difference between the STAI-S and STAI-T scores of mothers and fathers during the preoperative period. However, in the postoperative 1. h, anxiety levels increased significantly in both parents (p = 0.001) and then gradually decreased. All mothers, and the parents of the children aged 4-<10 years had significantly higher anxiety levels at all preoperative and postoperative time points (p < 0.001). Anxiety scores were higher in mothers in the American Society of Anesthesiologists (ASA) III group, and anxiety levels were also significantly increased in parents with a history of previous major surgery (p < 0.05). In contrast, increasing experience with stone surgery had a reducing effect on parental anxiety (p < 0.01). FIS scores increased significantly during the transfer of the patients from the waiting room to the operating room (p < 0.001). Although FIS scores decreased somewhat in the inpatient unit, they still remained above their preoperative levels.

CONCLUSION: Parental anxiety during pediatric stone surgery increases significantly, especially in the early postoperative period, and is influenced by factors such as the child's age, ASA score, and prior surgical history. The results indicate that the psychological state of the parents is closely related to the emotional and clinical recovery processes of their children. Children's anxiety rose during transfer to the operating room and remained above baseline postoperatively.