Patients' quality of life following extracorporeal shock-wave lithotripsy and percutaneous nephrolithotomy for renal calculi

The impact of kidney stone disease on quality of life in high-risk stone formers

OBJECTIVE

To assess the impact of kidney stone disease (KSD) and its treatment on the health-related quality of life (HRQOL) of high-risk stone formers with hyperparathyroidism, renal tubular acidosis, malabsorptive disease, and medullary sponge kidney.

PATIENTS AND METHODS

The Wisconsin Stone Quality of Life questionnaire was used to evaluate HRQOL in 3301 patients with a history of KSD from 16 institutions in North America between 2014 and 2020. Baseline characteristics and medical history were collected from patients, while active KSD was confirmed through radiological imaging. The high-risk group was compared to the remaining patients (control group) using the Wilcoxon rank-sum test.

RESULTS

Of 1499 patients with active KSD included in the study, the high-risk group included 120 patients. The high-risk group had significantly lower HRQOL scores compared to the control group (P < 0.01). In the multivariable analyses, medullary sponge kidney disease and renal tubular acidosis were independent predictors of poorer HRQOL, while alkali therapy was an independent predictor of better HRQOL (all P < 0.01).

CONCLUSIONS

Among patients with active KSD, high-risk stone formers had impaired HRQOL with medullary sponge kidney disease and renal tubular acidosis being independent predictors of poorer HRQOL. Clinicians should seek to identify these patients earlier as they would benefit from prompt treatment and prevention.

How has the COVID-19 pandemic changed treatment preferences of patients with proximal ureteral stones?

Background

The impact of the coronavirus disease 2019 (COVID-19) pandemic on patient decision making remains uncertain. This study aimed to investigate the effect of the pandemic on treatment preferences of patients with proximal ureteral stones.

Materials and methods

Retrospective data regarding treatment preferences of patients diagnosed with symptomatic proximal ureteral stones between July 2018 and November 2021 at a single center were analyzed. Data from 493 patients were analyzed according to 2 groups, including patients diagnosed during the COVID-19 pandemic and those diagnosed during an equivalent period of time before the pandemic.

Results

Preference for conservative treatment increased during the COVID-19 pandemic (p = 0.009). In patients who had previously undergone shock wave lithotripsy (SWL), the preference for SWL decreased and the preference for conservative treatment increased during the COVID-19 pandemic (p = 0.042). Multiple logistic regression analysis revealed a significant correlation between a preference for conservative treatment during the pandemic and no prior spontaneous stone passage (p = 0.003; odds ratio [OR], 2.48; 95% confidence interval [CI], 1.45-4.23), no hydronephrosis (p = 0.035; OR, 3.57; 95% CI, 1.34-9.49), and a visual analog scale score of 4 or less (p = 0.018; OR, 1.97; 95% CI, 1.15-3.38).

Conclusions

A significant increase in the preference for conservative treatment was observed among patients diagnosed during the pandemic, and patients with a history of SWL demonstrated a preference shift from SWL to conservative treatment.

Efficacy of PCNL in the resolution of symptoms of nephrolithiasis

Patients undergo Percutaneous Nephrolithotomy (PCNL) for the resolution of pain, but at times, other symptoms such as hematuria, dysuria, nausea, emotional distress, and anxiety are also the presenting symptoms. While pain resolution after successful surgery is generally the focus, the resolution rate of other symptoms after surgery is not described. Our study aims to determine the efficacy of PCNL for the resolution of other symptoms. Patients aged > 18 years who underwent PCNL from September 2019 to 2021 were interviewed face-to-face and asked questions regarding their symptoms before and 3 months after the surgery. Their response was noted on an 11-point Numerical-Rating-Scale (NRS) of 0-10. The primary outcome was symptom resolution rate at 3 months after PCNL. The secondary outcomes were rate of resolution of gross hematuria, dysuria, anorexia and nausea, emotional distress and anxiety, work interference, and daily routine activities. Only patients who had complete stone clearance in a single sitting were included. Of the total 110 patients, almost half (45.45%) of the patients reported having one or more symptoms at or after 3 months of surgery. The reduction in proportion of patients and mean difference in preoperative and postoperative NRS scores of symptoms were statistically significant. Symptoms that persisted were mild and posed slight discomfort to the patient. Complete resolution of all the symptoms may not be achieved even in patients who have complete clearance after PCNL, and a few symptoms can persist, however, only mild. Appropriate preoperative counselling of the patients is, therefore, essential.

Health questionnaire analysis and development of satisfaction questionnaire for patients treated with extracorporeal shock wave lithotripsy (SATISLIT)

INTRODUCTION

Due to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated.

MATERIAL AND METHODS

The design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients' sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL.

RESULTS

135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39). Differences in global ESPTL score between men and women (p <.001), as well as in items 1 (p =.029), 3 (p =.002), 6 (p =.006), 7 (p =.005) and 8 (p =.025). Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (<0.2). 4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p =.001), F3 (p =.007) and F4 (p =.001). Significant correlation with age only in F1 and F3, but very weak (<0.2). Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients' sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p <.001).

CONCLUSIONS

Based on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients' satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness.

Do the residual fragments after shock wave lithotripsy affect the quality of life?

OBJECTIVE

To evaluate the possible effects of residual fragments on the health-related quality of life in patients undergoing extracorporeal shockwave lithotripsy for renal stones.

PATIENTS AND METHODS

Seventy-one patients with residual fragments were divided into 2 further groups; group 1 (n = 42; fragment size, ≤ 4 mm) and group 2 (n = 29; fragment size, >4 mm). During 3-month follow-up, spontaneous passage rates; number of emergency department visits, amount of the analgesic required, additional procedures, and the changes in the quality of life were evaluated. Quality of life was evaluated using the Short Form 36 survey. Statistical analyses included independent sample t tests.

RESULTS

Of the 42 cases with fragments ≤ 4 mm, although 92.8% patients passed the fragments spontaneously, fragments resided until 3 months in 4.8% patients. Again, after 2 sessions of extracorporeal shockwave lithotripsy, of the 29 cases with fragments >4 mm, 55% were stone free, whereas 14% still had residual fragments. Mean number of emergency department visit was found to be 0.07 and 0.5 in both groups, respectively. Mean analgesic need was 138.75 mg in group 1 and 375 mg in group 2. Although significantly lower scores were noted only for one parameter during 1-month evaluation in cases with larger fragments, they were present in all 8 parameters during 3-month evaluation.

CONCLUSION

Larger residual fragments could significantly affect the quality of life. Emergency department visits and colic attacks are the causes of discomfort. Effective stone disintegration by an experienced urologist should be aimed to limit the negative effects of residual fragments on the quality of life.

How do the residual fragments after SWL affect the health-related quality of life? A critical analysis in a size-based manner

This study aimed at evaluating the possible effects of residual fragments (RF) after shockwave lithotripsy (SWL) on the health-related quality of life (QOL) of the patients on a size-related basis. Eighty six patients with RF after SWL were divided into three groups: Group 1 (n:30 with fragments ≤ 2 mm), Group 2 (n:21 2-≤ 4 mm) and Group 3 (n:35 > 4 mm). During a 3-month follow-up, spontaneous passage rates, emergency department visits, mean analgesic required, additional procedures and the QOL were all evaluated. QOL was evaluated using the Short Form-36 survey. Of the 30 patients with fragments ≤ 2 mm all cases passed the fragments spontaneously. Of the 21 cases with fragments 2-≤ 4, however, 76% were stone free. Last, of the 35 cases with fragments >4 mm, 52% passed them spontaneously in 3 months. While no patient with fragments ≤ 2 mm required emergency department visit, 19% of the cases with fragments 2-≤ 4 mm and 51.4 % with fragments >4 mm did require this visit. Mean analgesic need (mg) values were higher in cases with larger fragments. Evaluation of the QOL score data in a subgroup comparison base showed that cases with larger fragments had prominently lower scores during both 1- and 3-month evaluation. RF after SWL could pose an impact on the QOL of the cases in a size-related basis. While fragments ≤ 2 mm had nearly no impact on this aspect larger fragments could significantly affect the QOL.

Development of an instrument to assess the health related quality of life of kidney stone formers

PURPOSE

Urolithiasis is associated with pain and other decreases in health related quality of life, yet there is no urolithiasis specific instrument to measure quality of life. Quality of life is an important end point in the management of urolithiasis. Therefore, we developed the Wisconsin StoneQOL, a disease specific instrument to assess the quality of life of patients with urolithiasis.

MATERIALS AND METHODS

Patients and urology providers identified important concepts related to quality of life of stone formers in groups and in individual cognitive interviews. Patients were recurrent stone formers including those with and those without current stones. A preliminary instrument was created, followed by patient feedback and item reduction. A 28-question instrument was ultimately developed which was tested for reliability as well as internal face, construct and discriminant validity in 248 stone formers.

RESULTS

The internal consistency (for questions within domains) was high (mean Cronbach's α = 0.81). Correlation between domains was confirmed (Cronbach's α = 0.86). Discriminant validity was shown as stone formers with current stones scored lower than those who were stone-free. Among patients with active stones, those with symptoms scored lower on most questions and for the total score (p <0.0001) than those who were asymptomatic.

CONCLUSIONS

The Wisconsin StoneQOL holds promise as a disease specific instrument that captures the unique symptoms and challenges associated with urolithiasis. As such, the Wisconsin StoneQOL is capable of assessing the health related quality of life of stone formers at various points along the disease continuum. Future assessment will establish minimal clinically important differences for use in individual patients.

Study of quality of life and its determinants in patients after urinary stone fragmentation

BACKGROUND

This study was designed to evaluate the health-related quality of life (HRQOL) of patients who had undergone lithotripsy for treatment of urinary stones and to identify factors that significantly affect the HRQOL of these patients.

METHODS

A comparative cross-sectional study was performed at the main university and main Ministry of health hospitals in Riyadh, Saudi Arabia. All patients admitted to the urology service and who underwent lithotripsy for urinary stones during a 9-month period were included in the study. An observation period of 3-15 months following the last treatment was allowed before patients completed the QOL questionnaire. Information on socio-demographic, and medical characteristics, and number and type of lithotripsies were collected. The Medical Outcome Study Short-Form 36-item survey (SF-36) was used to assess HRQoL. For comparison, the HRQoL in an equal number of healthy individuals was investigated; multivariate analysis of variance was used for comparisons between groups.

RESULTS

Compared with healthy subjects, lithotripsy patients had significantly higher mean scores in the different subscales of the SF-36 questionnaire such as physical functioning, vitality, role-physical, role-emotional and mental health, indicating a better HRQOL. Compared with patients who underwent ureteroscopic or extracorporeal shock-wave lithotripsies, those who underwent percutaneous lithotripsy had significantly worse mean scores for all the SF-36 scales, except for body pain. Factors impacting HRQOL of the patients were age, obesity, diabetes mellitus, and stone characteristics such as localization (in the kidney) and recurrence (multiple lithotripsies).

CONCLUSIONS

Post-lithotripsy, patients have a favorable HRQOL compared with healthy volunteers. Further prospective studies are warranted to confirm these results owing to the inherent limitations of the cross-sectional design and backward analysis of this study.

Determinants of quality of life for patients with kidney stones

PURPOSE

We evaluated various factors relating to quality of life in a population of patients with stones.

MATERIALS AND METHODS

A total of 155 patients seen at our urology clinic for stones between January and May 2007 were prospectively questioned regarding stone history and were administered the SF-36 questionnaire to assess quality of life. Age, body mass index, American Society of Anesthesiologists score, number of stone episodes, interval from the last stone episode, number of surgical procedures for stones and associated complications, missed days of work and long-term medical treatment were elicited from the patients. Individual SF-36 domains and composite scores were compared to those of the American general population. Univariate and multivariate regression analyses were performed to assess the impact of all covariates on quality of life scores.

RESULTS

Patients with stones scored lower than the average American population in 5 of the 8 domains of the SF-36 as well as in the physical composite score. Multivariate regression modeling showed that increasing body mass index and age were the strongest predictors of decreased physical well-being. The number of stone episodes did not influence SF-36 scores, although the number of surgical procedures impacted physical and mental components. The number of ureteroscopy procedures and stent placements primarily impacted mental well-being. Medical therapy, particularly the use of potassium citrate, was associated with more favorable quality of life.

CONCLUSIONS

Various factors impact quality of life in patients with urolithiasis but the most important are body mass index, age and the number of surgical procedures. Prospective longitudinal studies may further elucidate the determinants of quality of life and they might be used to optimize patient care.

Health-related quality of life in patients undergoing lithotripsy for urinary stones

OBJECTIVES

The objective of this study was to analyze the health-related quality of life (HRQoL) in patients undergoing lithotripsy for urinary stones.

MATERIALS AND METHODS

This study comprised 76 patients with urinary stones who were treated by lithotripsy, which included shock wave lithotripsy (SWL), ureteroscopic lithotripsy, percutaneous nephrolithotripsy and ureterolithotomy in 66 patients, 25 patients, six patients and three patients, respectively. During the observation period of this series, 37 patients received additional lithotripsy for recurrent urinary stones. HRQoL was evaluated using the Short Form-36 (SF-36) survey assessing eight aspects associated with general health status.

RESULTS

There were no significant differences in any scale scores between the 76 patients with urinary stones and age- and gender-matched Japanese norms. Bodily pain (BP) in 37 patients undergoing lithotripsy twice or more appeared to be significantly lower than that in 39 undergoing lithotripsy only once; however, there were no significant differences in the remaining seven scores according to the number of courses of lithotripsy. Furthermore, 47 patients treated by SWL alone had a significantly higher score for general health perception (GH) than 29 who underwent lithotripsy by methods other than SWL, while there were no significant differences in the remaining seven scores between these two groups.

CONCLUSIONS

In general, patients undergoing lithotripsy for urinary stones may have a comparatively favorable HRQoL; however, BP and GH were impaired in patients undergoing lithotripsy twice or more and those treated by invasive modalities, respectively. Considering these findings, it would be important to prevent recurrent stone formation and to develop less invasive procedures to further improve HRQoL in patients undergoing lithotripsy for urinary stones.

Effects of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy on renal function and prostaglandin excretion

The aim of the study was to investigate the effects of percutaneous nephrolithotomy (PCN) and extracorporeal shock wave lithotripsy (ESWL) on renal function and urinary prostaglandin excretion. Twenty/ESWL patients and 20 PCN patients were studied pre-, 24 h and two weeks after treatment. Twenty-four hours after treatment PCN resulted in a fall in serum potassium, sodium and calcium. There was a small rise in urinary prostaglandin excretion. All results had returned to normal by two weeks. ESWL caused a rise in serum creatinine with a fall in calculated glomerular filtration rate (GFR). This was coupled with a fall in urinary excretion of sodium, potassium, and calcium. There was a rise in urinary prostaglandin excretion. Serum calcium and LDH levels also rose. All results had returned to normal by two weeks except urinary calcium excretion, and serum albumin had now fallen. ESWL had more effect on renal function in the acute phase of treatment than PCN.

Percutaneous nephrolithotomy in the elderly

OBJECTIVES

To evaluate the success and morbidity of percutaneous nephrolithotomy (PNL) performed in patients aged 65 years and older.

METHODS

A retrospective review of 42 PNLs performed on 33 patients aged 65 years and older was compared with a cohort of 160 PNLs performed on younger patients over the same time period.

RESULTS

The presence of complete staghorn calculi (17 of 36 renal units [47%] versus 88 of 160 renal units [55%], p = 0.46) and average stone size (3.8 cm versus 4.3 cm, p = 0.2) were similar for the 2 groups. Eighty-two percent of patients (27 of 33) were stone-free or left with fragments < 5 mm at 3 months after surgery. Elderly patients had a higher transfusion rate after PNL despite similar preoperative hemoglobin levels (11 of 42 PNLs [26%] versus 22 of 160 PNLs [14%], p < 0.01). Serious complications were infrequent and there were no deaths.

CONCLUSIONS

Percutaneous nephrolithotomy is a safe and effective therapy for elderly patients with complex stone disease; however, awareness of an apparent increased requirement for blood transfusion is warranted.

Quality-of-life measurement in surgical practice

Assessment of quality of life is gaining momentum in areas of medical practice where standard measures of outcome are not sensitive enough to determine treatment strategies. Such methods have not been widely adopted in the surgical specialties, although this is changing. The techniques used are easily understood but they have not been standardized and are subject to several confounding factors. Nevertheless, quality-of-life measurement may provide additional information in the research environment and surgical audit.