The impact of the number of lifetime stone events on quality of life: results from the North American Stone Quality of Life Consortium

Association of health-related quality of life with urinary tract infection among kidney stone formers

Kidney stones and infections significantly affect patients' health-related quality of life (HRQOL); however, the relationship between urinary tract infections (UTIs) and HRQOL in patients with kidney stones remains unclear. This study aimed to investigate the relationship using the validated Chinese version of the Wisconsin Stone Quality of Life questionnaire (C-WISQOL). We prospectively recruited 307 patients with kidney stones to complete the C-WISQOL before and after stone removal. The participants were diagnosed with UTI based on the presence of pyuria or bacteriuria with or without clinical symptoms. The psychometric properties of the C-WISQOL were statistically analyzed. Multivariate linear regression was used to predict the risk factors for impaired HRQOL in patients with stones and UTIs. The questionnaire is a reliable and robust tool for evaluating HRQOL in Chinese-speaking patients with urolithiasis. The UTI and kidney stone co-occurrence was significantly associated with female sex, diabetes mellitus, more previous stone events, higher antibiotic usage, positive stone- or UTI-related symptoms, and postoperative residual stones. The preoperative C-WISQOL scores and improvement in the HRQOL after stone removal in patients clinically diagnosed with UTI were significantly inferior to those in patients without UTI. The regression analyses showed that worse HRQOL was predicted by more previous stone events and positive stone- or UTI-related symptoms. In contrast, the presence of diabetes mellitus and postoperative residual stone fragments predicted a lower improvement in the HRQOL. These findings underscore UTI's harmful impact on perioperative HRQOL in patients with kidney stones and could help strategies benefit those patients.

Cost-effectiveness of one-stop-shop [18F]Fluorocholine PET/CT to localise parathyroid adenomas in patients suffering from primary hyperparathyroidism

PURPOSE

We conducted a cost-effectiveness analysis in which we compared a preoperative [18F]Fluorocholine PET/CT-based one-stop-shop imaging strategy with current best practice in which [18F]Fluorocholine PET/CT is only recommended after negative or inconclusive [99mTc]Tc-methoxy isobutyl isonitrile SPECT/CT for patients suffering from primary hyperparathyroidism. We investigated whether the one-stop-shop strategy performs as well as current best practice but at lower costs.

METHODS

We developed a cohort-level state transition model to evaluate both imaging strategies respecting an intraoperative parathyroid hormone monitored treatment setting as well as a traditional treatment setting. The model reflects patients' hospital journeys after biochemically diagnosed primary hyperparathyroidism. A cycle length of twelve months and a lifetime horizon were used. We conducted probabilistic analyses simulating 50,000 cohorts to assess joint parameter uncertainty. The incremental net monetary benefit and cost for each quality-adjusted life year were estimated. Furthermore, threshold analyses regarding the tariff of [18F]Fluorocholine PET/CT and the sensitivity of [99mTc]Tc-methoxy isobutyl isonitrile SPECT/CT were performed.

RESULTS

The simulated long-term health effects and costs were similar for both imaging strategies. Accordingly, there was no incremental net monetary benefit and the one-stop-shop strategy did not result in lower costs. These results applied to both treatment settings. The threshold analysis indicated that a tariff of €885 for [18F]Fluorocholine PET/CT was required to be cost-effective compared to current best practice.

CONCLUSION

Both preoperative imaging strategies can be used interchangeably. Daily clinical practice grounds such as available local resources and patient preferences should inform policy-making on whether a hospital should implement the one-stop-shop imaging strategy.

Measuring quality of life in patients with kidney stone disease: is it the future in endourology?

PURPOSE OF REVIEW

Kidney stone disease is recognized to negatively impact quality of life. This pertains to acute episodes, surgical interventions and even during asymptomatic periods. Over time there has been increased attention towards assessing this subjective parameter, including as a determinant of treatment success. Our aim was to evaluate the current status and emerging trends in this field.

RECENT FINDINGS

Patient groups most affected appear to be recurrent stone formers, cystine stone formers, women, younger populations, non-Caucasians and low-income populations. Several stone specific patient reported outcome measures are now available of which, WISQol has been implemented the most in clinical research studies. More invasive interventions such as percutaneous nephrolithotomy impede quality of life to greater extent than alternatives such as shockwave lithotripsy.

SUMMARY

There are certain patient groups who are more vulnerable to the negative impact of kidney stone disease on their quality of life. Urologists can improve patient care by recognizing these particular populations as well as by implemented patient reported outcome measures in their routine clinical practice and when performing research.

Translation and validation of the Italian version of the Wisconsin Stone Quality of Life Questionnaire (I-WISQOL) for assessing quality of life in patients with urolithiasis

BACKGROUND

Urolithiasis is a chronic condition, and it has been associated with a significant negative impact on patients' health-related quality of life (HRQOL). Several tools to assess patients' HRQOL have been validated in Italian, however disease-specific HRQOL instruments are still lacking. We aimed to develop and validate the Italian version of the WISQOL (I-WISQOL) in patients with urolithiasis.

METHODS

The Italian version of the WISQOL was developed in a multistep process involving primary translation, back-translation, and pilot testing among a group of patients (N.=10). Patients presenting with urolithiasis were prospectively recruited from the outpatient stone clinics and completed both questionnaire WISQOL and SF-36. Demographic information, as well as medical and surgical data, were obtained through an interview. Internal consistency of the I-WISQOL was obtained with Cronbach's α. Correlation of total scores of the I-WISQOL and SF36 was assessed to determine convergent validity using Spearman Rho. Correlations between clinical variables and results from the I-WISQOL were analyzed to descriptively assess the association of interest.

RESULTS

A total of 93 participants were evaluated and completed the Italian version of the I-WISQOL. The I-WISQOL demonstrated excellent internal consistency (Cronbach's α 0.95) and good convergent validity with the validated SF-36 (Spearman Rho r=0.70, P<0.001). Using ANOVA analysis, a significant decline in WISQOL Score was noted with the increasing number of renal colics (P=0.0543), ER visits (P=0.037), number of inpatient hospitalization (P=0.025). At multivariate analysis, worse WISQOL total score was predicted by a greater number of renal colic events (ß=-4.92 [-8.81-1.04], P=0.014) and by a greater number inpatient hospitalization (ß=-7.31 [-14.35 -0.26], P=0.042).

CONCLUSIONS

The I-WISQOL is an internally consistent and valid instrument to assess HRQOL in Italian-speaking patients with kidney stones. Its use in clinical practice should be implemented in order to tailor the management of each patient.

Development and Preliminary Validation of the 6-Item Short Form of the Wisconsin Stone Quality of Life Questionnaire

OBJECTIVE

To develop a short form of the Wisconsin Stone Quality of Life (WISQOL): 1) identify the smallest subset of items from WSIQOL that accurately predict patients' health-related quality of life (HRQOL), and 2) in a clinical patient population, test these items-grouped together to form the WISQOL-short form (SF) - and assess its convergent validity.

MATERIALS AND METHODS

The items for the WISQOL-SF were identified based on classic item analysis theory. Patients who previously completed the original 28-item WISQOL were randomly split into 2 groups of equal size. Scores for the WISQOL were calculated for one group while those for the WISQOL-SF were calculated for the other. Cronbach's alpha coefficients were calculated. Impacts of demographic and clinical factors as well as stone and symptom status at the time of WISQOL completion were examined.

RESULTS

Patients (n = 740) who completed the WISQOL between 6/2017 and 11/2021 were included. Patients were 48% male, 54.1 ± 14.6 years old, and had a BMI of 31.2 ± 8.1. After item analysis and reduction, the six items ultimately included in the WISQOL-SF represented 2 of the 4 domains (social and emotional) of the original WISQOL. The internal consistency of the WISQOL-SF was similar to the original (Cronbach's alpha 0.943 vs. 0.973). No differences for health-related quality of life were found between groups (P = .567).

CONCLUSION

The WISQOL-SF demonstrated the expected differences for gender and between patients with and without stone-related symptoms at the time of WISQOL completion. The WISQOL-SF showed good consistency and produced similar HRQOL scores to the full-form WISQOL.

Metabolic evaluation: is there really a future?

PURPOSE OF REVIEW

To confirm the need for a metabolic evaluation in stone formers based on the latest information published in the last 24 months and in the current 2022 American and European urological guidelines.

RECENT FINDINGS

Recent studies suggest that urolithiasis prevalence has been increasing since 1990. Along with it, metabolic abnormalities that contribute to the development of kidney stones are also increasing, such as hyperuricosuria, hyperoxaluria, hypocitraturia, hypomagnesuria, hypocalciuria, hypophosphaturia, and hyperuricemia. Those abnormalities can only be detected through a metabolic evaluation in patients with stone disease.

SUMMARY

It is important for us, urologists, to have in mind the actual stone prevalence worldwide. As part of our initial evaluation of the patient with urolithiasis, we must not forget to perform the basic metabolic analysis and, according to the patient's risk classification, continue with a deep metabolic analysis. This extensive analysis includes blood and urine tests. The urinalysis covers 24-h urinalysis, and it would be accurate to also have an early fresh urine analysis. Moreover, identifying the stone type is intimately correlated with the search for other metabolic parameters.

The duration of stone disease and the impact of a stone event on patients' quality of life

INTRODUCTION

With a 5-year stone recurrence rate of 30-50%, kidney stone formers are subject to significant morbidity which negatively impacts their Health Related Quality of Life (HRQOL). We sought to determine the impact of age of kidney stone onset, duration of stone disease, and kidney stone event (surgery or stone passage) on patients' individual HRQOL by querying the validated and prospectively collected Wisconsin Stone Quality of Life (WISQOL) database.

MATERIALS AND METHODS

Cross-sectional data were obtained from a total of 2,438 kidney stone formers from 14 institutions in North America who completed the WISQOL questionnaire from 2014 to 2019. The 28-question survey has a 1-5 point scale for each item (total score range 0-140). Multivariable linear regression models assessed the impact of age of kidney stone onset, duration of stone disease and time since most recent surgery or stone passage on HRQOL.

RESULTS

Of 2,438 patients, older age at kidney stone onset and longer duration of disease were both independent predictors of better WISQOL (β=0.33 points/year; CI 0.17-0.49; p<0.001 and β=0.50 points/year; CI 0.32-0.68; p<0.001, respectively). Of 1,376 patients with surgery between 2010-2019, increased time since most recent surgery was an independent predictor of better WISQOL scores (β = 2.28 points/year; CI: 1.47-3.10; p=<0.001). Of 1,027 patients with spontaneous stone passage between 2010-2019, increased time since most recent stone passage was an independent predictor of better WISQOL scores (β = 1.59 points/year; CI: 0.59-2.59; p=<0.05).

CONCLUSION

Our study demonstrates that older age of onset, longer duration of disease, increase time from most recent surgery or stone passage were independent predictors of better HRQOL in kidney stone formers. Results of future studies that focus on optimizing stone related modifiable risk factors to decrease the amount of recurrent stone episodes and thus the need for recurrent surgeries will be essential.