Preliminary Evidence of Decreased Disease-Specific Health-Related Quality of Life in Asymptomatic Stone Patients

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.

Gender Disparities in Quality of Life Outcomes Among Kidney Stone Formers

Purpose: This study investigates gender-based disparities in health-related quality of life (HRQOL) outcomes among kidney stone patients and explores potential contributing factors. Methods: A retrospective review of medical records at the University of Rochester Medical Center was conducted on 2199 new urolithiasis patients who completed the Wisconsin Stone Quality of Life Questionnaire (WISQOL) standardized on a 0 to 100 scale. Demographic and clinical data were collected. Statistical analyses included univariate tests, chi-squared tests, and multivariate linear regression. Results: Of the 2199 kidney stone patients, 1085 (49.3%) were women. Women reported significantly lower quality of life (QoL) scores compared with men (71.6 vs 80.7; p < 0.001), and this persisted across all domains, including social impact (80.2 vs 86.9; p < 0.001), emotional impact (67.3 vs 77.1; p < 0.001), disease impact (67.3 vs 77.1; p < 0.001), and impact vitality (62.6 vs 72.9; p < 0.001). Female gender was identified as an independent predictor of diminished QoL scores, along with younger age, symptomatic status, number of surgeries, and presence of a psychosocial comorbidity. Conclusions: Our findings suggest that women with kidney stones experience lower HRQOL compared with men, even accounting for clinical and demographic factors. Although this study provides preliminary insights, additional research is needed to validate these findings in broader and more varied populations.

Postoperative Recovery of Quality-of-Life Following Ureteroscopy for Nephrolithiasis: The Impact on Pain Intensity and Interference and the Ability to Participate in Social Roles

OBJECTIVE

To prospectively capture patient-reported outcomes to assess the recovery profile of ureteroscopy (URS).

MATERIALS AND METHODS

Adults undergoing URS for renal/ureteral stones were eligible for inclusion (11/2020-8/2022). Patients prospectively completed PROMIS - Pain Intensity, - Pain Interference, and - Ability to participate in social roles and activities in-person preoperatively (POD 0) and via email on POD 1, 7, 14, and 30. Scores are reported as T-scores (normalized to U.S. population, mean=50) with a change of 5 (0.5 SD) considered clinically significant.

RESULTS

One hundred and seventy-eight participants enrolled at POD 0 (POD 1 =87, POD 7 =83, POD 14 =70, POD30 =67). There was a worsening of quality of life from day 0 to day 1 and day 0 to 7. All dimensions then improved with an increase in scores from day 0 to day 14 and day 0 to day 30. On multivariable analysis, the presence of a preoperative ureteral stent (OR 0.14) and use of semirigid URS (OR 0.33) were associated with a reduced odds for severe pain interference at day 1. The use of semirigid URS (OR 0.20) was associated with a reduced odds for severe worsening in the ability to participate in social roles at day 1.

CONCLUSION

Ability to participate in social roles declines immediately postoperatively, while pain intensity and interference sharply increase. There is a gradual improvement until POD 30. Findings suggest preoperative stents may influence postoperative recovery. Results offer meaningful insight to assist in counseling and setting expectation for patients postoperatively.

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.

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.

The Impact of Bilateral Stone Disease on Patients' Disease Progression and Health-Related Quality of Life

Purpose: Patients with recurring kidney stone events can expect significant morbidity and functional impairment. Few studies have evaluated the effect of bilateral kidney stones on disease progression and quality of life. We wanted to determine the association of bilateral stone disease on age of onset, and the impact on number of stone events and individual kidney stone disease-specific health-related quality of life (HRQOL) by analyzing the validated and prospectively collected Wisconsin Stone Quality of Life (WISQOL) database. Materials and Methods: We studied 2906 stone patients from 16 centers in North America after having completed the WISQOL questionnaire from 2014 to 2019. Kidney stone formers were assessed if kidney stones were bilateral or unilateral on imaging. Analysis with a chi-square test compared categorical variables. Bilateral kidney stone disease and its impact on HRQOL were evaluated through a multivariable linear regression model. Results: Of 2906 kidney stone formers, 1340 had unilateral kidney stones and 1566 had bilateral kidney stones. We observed more frequently that patients with bilateral stones had an increased number of depression/anxiety symptoms, renal tubular acidosis, and rheumatoid arthritis (all p < 0.05). Patients with bilateral stones had a younger mean (standard deviation [SD]) age of kidney stone disease onset (37.2 ± 15.8 vs 46.4 ± 15.9 years of age, p < 0.001). Bilateral kidney stone formers had a higher mean (SD) number of stone events (11.3 ± 21.8) than unilateral kidney stone formers (3.0 ± 5.1) (p < 0.001). Within our multivariable analysis, we found that HRQOL was negatively affected by the presence of bilateral stones for kidney stone patients (β = -11.2 [confidence interval: -19.5 to -3.0] points, p < 0.05). Conclusions: Bilateral kidney stone formers had a younger age of kidney stone disease onset and a higher number of stone events compared with unilateral kidney stone disease formers. The presence of bilateral kidney stone disease negatively impacted HRQOL.

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.

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.

Introducing Trifecta for percutaneous nephrolithotomies: a proposal for standard reporting outcomes after treatment for renal stones

BACKGROUND

In literature, the reports of outcomes after percutaneous nephrolithotomies are rather heterogeneous. This may influence studies comparison, it may also render difficult to evaluate surgical adequacy, peri-operative morbidity and patient's quality of life between studies. For this reason, we propose to introduce PNL-Trifecta as composite measure to standardize data reporting outcomes after percutaneous nephrolithotomies.

METHODS

We performed a prospective multicentric study on consecutive patients undergone PNL to treat renal stones between 2018 and 2020. Successful PNL-trifecta was considered achieved when procedures obtained the three following results: no residual fragments > 2mm at unenhanced CT scan at 3 months post-op, no complications (defined as Clavien-Dindo Score 0) and operation carried out without placing a nephrostomy tube (tubeless or totally tubeless). We compared results of standard versus mini-PNL and between stones of different complexity (evaluated with Guy's Stone Score and S.T.O.N.E. nephrolithometry Score). Univariate analysis was utilized to identify other factors influencing achievement of PNL-Trifecta.

RESULTS

245 patients fulfilled inclusion/exclusion criteria and have been enrolled in the study (median age: 56, IQR 48-57). The overall PNL-Trifecta achievement rate was 22.85% (28.66% in the mini-PNL group and 13.68% in the standard-PNL group, p=0.010). The stone free rate, CD 0 rate and tubeless/totally tubeless rate in the mini-PNL group were 60.66%, 89.33% and 51.33% respectively. In the standard-PNL group they were 44.21%, 40.00% and 15.78% respectively. At the univariate analysis, differences between Guy's Stone Score groups in achieving PNL-Trifecta were significant (p=0.001). Also, the level of upper puncture (p=0.010) and utilization of device with active suction (p=0.002) showed statistically significant differences. Furthermore, the length of stay in the patient's group achieving Trifecta was 2.28 versus a mean length of stay of 4.64 days in the group of patients not achieving Trifecta (p=0.046).

CONCLUSIONS

We present Trifecta for PNLs as a potential tool to evaluate quality of percutaneous nephrolithotomies and to provide an instrument for an adequate standard data reporting. It can represent a valid way to assess and monitor surgeon's learning curves. It will require further external validation and studies to evaluate its correlation with mid- and long-term results and patient's health related quality of life outcomes.

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

To evaluate the impact of chronic stone recurrence on an individual's quality of life using the validated Wisconsin Stone Quality of Life (WISQOL) questionnaire. We collected cross-sectional data on patients with kidney stones from 14 institutions in North America. A stone event was defined as renal colic, stone-related procedure or emergency department visit. The regression analyses using general linear models and pairwise comparison determined the impact of the number of stone events on quality of life. The median number of stone events among the 2205 patients who completed the questionnaire was 3 (IQR 1-6). The mean total score was 107.4 ± 28.7 (max 140 points). The number of lifetime stone events was an independent predictor of lower quality of life (p < 0.001), specifically, score declined significantly beyond five events. Compared with patients who experienced a single stone event, there was a 0.4, 2.5, and 6.9 point decline in the adjusted mean WISQOL score after 2-5, 6-10, or > 10 events, respectively. The cumulative number of lifetime stone events was associated with a lower quality of life when more than five stone events were occurred. These findings underscore the importance of efforts to determine the underlying metabolic etiology of urolithiasis in the recurrent stone former, and the institution of a regimen to place their stone disease in remission.

Comparison of Selective Versus Empiric Pharmacologic Preventative Therapy With Kidney Stone Recurrence

OBJECTIVE

To assess the effectiveness of an empiric approach to metabolic stone prevention.

METHODS

Using medical claims from a cohort of working age adults with kidney stone diagnoses (2008-2017), we identified the subset who were prescribed thiazides, alkali therapy, or allopurinol-collectively known as preventive pharmacologic therapy (PPT). We distinguished between those who had 24-hour urine testing prior to initiating PPT (selective therapy) from those without it (empiric therapy). We conducted a survival analysis for time to first recurrence for stone-related events, including ED visits, hospitalizations, and surgery, up to 2 years after initiating PPT.

RESULTS

Of 10,125 patients identified, 2744 (27%) and 7381 (73%) received selective and empiric therapy, respectively. The overall frequency of any stone-related event was 11%, and this did not differ between the 2 groups on bivariate analysis (P = .29). After adjusting for sociodemographic factors, comorbidities, medication class, and adherence, there was no difference in the hazard of a stone-related event between the selective and empiric therapy groups (hazard ratio, 0.97; 95% confidence interval, 0.84-1.12). When considered individually, the frequency of ED visits, hospitalizations, and surgeries did not differ between groups. Greater adherence to PPT and older age were associated with a lower hazard of a stone-related event (both P < .05).

CONCLUSION

Compared to empiric therapy, PPT guided by 24-hour urine testing, on average, is not associated with a lower hazard of a stone-related event. These results suggest a need to identify kidney stone patients who benefit from 24-hour urine testing.

Estimating the health-related quality of life of kidney stone patients: initial results from the Wisconsin Stone Quality of Life Machine-Learning Algorithm (WISQOL-MLA)

OBJECTIVE

To build the Wisconsin Stone Quality of Life Machine-Learning Algorithm (WISQOL-MLA) to predict urolithiasis patients' health-related quality of life (HRQoL) based on demographic, symptomatic and clinical data collected for the validation of the Wisconsin Stone Quality-of-Life (WISQOL) questionnaire, an HRQoL measurement tool designed specifically for patients with kidney stones.

MATERIAL AND METHODS

We used data from 3206 stone patients from 16 centres. We used gradient-boosting and deep-learning models to predict HRQoL scores. We also stratified HRQoL scores by quintile. The dataset was split using a standard 70%/10%/20% training/validation/testing ratio. Regression performance was evaluated using Pearson's correlation. Classification was evaluated with an area under the receiver-operating characteristic curve (AUROC).

RESULTS

Gradient boosting obtained a test correlation of 0.62. Deep learning obtained a correlation of 0.59. Multivariate regression achieved a correlation of 0.44. Quintile stratification of all patients in the WISQOL dataset obtained an average test AUROC of 0.70 for the five classes. The model performed best in identifying the lowest (0.79) and highest quintiles (0.83) of HRQoL. Feature importance analysis showed that the model weighs in clinically relevant factors to estimate HRQoL, such as symptomatic status, body mass index and age.

CONCLUSIONS

Harnessing the power of the WISQOL questionnaire, our initial results indicate that the WISQOL-MLA can adequately predict a stone patient's HRQoL from readily available clinical information. The algorithm adequately relies on relevant clinical factors to make its HRQoL predictions. Future improvements to the model are needed for direct clinical applications.

Is Stone-free Status After Surgical Intervention for Kidney Stones Associated With Better Health-related Quality of Life? - A Multicenter Study From the North American Stone Quality of Life Consortium

OBJECTIVE

To compare the health-related quality of life (HRQOL) of patients with residual fragments after surgical intervention for kidney stones to patients that are stone-free using the disease-specific Wisconsin stone quality of life (WISQOL) questionnaire. Kidney stones contribute to impaired HRQOL, which is increasingly recognized as an important healthcare outcome measurement.

MATERIALS AND METHODS

With institutional review board approval, 313 adult patients who underwent surgical intervention for kidney stones at 4 sites completed a WISQOL questionnaire. We retrospectively collected surgical data including presence of residual fragments on post-operative imaging. We calculated standardized WISQOL total and domain scores (0-100), which included items related to social functioning (D1), emotional functioning (D2), stone-related impact (D3), and vitality (D4). Scores were compared between patients with residual fragments to those who were stone-free after surgical intervention.

RESULTS

Demographics did not differ between groups, overall mean age 54.6 ± 13.5 and 55.4% female. There was no significant difference in total WISQOL score for patients with residual fragments (n = 124) compared to patients that were stone-free (n = 189), 110.5 ± 27.8 vs 115.4 ± 23.6 respectively, (P = .12). Interestingly, patients with residual fragments who underwent secondary surgery were found to have significantly lower total WISQOL score (88.4 ± 30.1 vs 116.6 ± 25.0, P <.0001).

CONCLUSION

Stone-free status after surgical intervention is not associated with better HRQOL when compared with patients whose surgeries left residual fragments. Indeed, further surgical intervention on residual fragments to achieve stone-free status may actually result in worse HRQOL.

The effect of shock wave lithotripsy and retrograde intrarenal surgery on health-related quality of life in 10-20 mm renal stones: a prospective randomized pilot study

The effects of treatment modalities such as retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) on health-related quality of life (HRQoL) were determined in patients with renal stones between 10 and 20 mm. A total of 120 patients were included in the study and prospectively randomized to RIRS or SWL group. A total of 39 patients experienced treatment failure and finally 81 patients (45 patients in the RIRS group, 36 patients in the SWL group) were analyzed for HRQoL. SF-36 survey was used to determine HRQoL pre-operatively, post-operative day 1 and 1 month. The patient and stone characteristics such as age, gender, stone size, grade of hydronephrosis and body mass index were similar between the two groups. At post-operative day 1, the RIRS group was associated with lower scores of role functioning/physical (p = 0.008), role functioning/emotional (p = 0.047) energy/fatigue (p = 0.011), social functioning (p = 0.003) and pain (p = 0.003) when compared to the SWL group. At post-operative 1 month, only pain and emotional well-being scores (p = 0.012 and p = 0.011, respectively) in the RIRS group were statistically lower according to the SWL group. In our study, patients in the SWL group showed more favorable HRQoL scores when compared to the patients in the RIRS group in short-term follow-up.

Screening for primary hyperparathyroidism in a tertiary stone clinic, a useful endeavor

INTRODUCTION AND OBJECTIVES

Primary hyperparathyroidism (1HPT) is associated with the risk of developing kidney stones. Our objective was to determine the prevalence of 1HPT amongst SF evaluated at a tertiary stone clinic and determine if it is cost-effective to screen for this condition.

METHODS

We retrospectively reviewed 742 adult SF seen by a single urologic surgeon from 2012 to 2017 all of who were screened for 1HPT with an intact serum PTH (iPTH) and calcium. The diagnosis of 1HPT was based on the presence of hypercalcemia with an inappropriately elevated iPTH or a high normal serum calcium and an inappropriately elevated iPTH. The diagnosis was confirmed by surgical neck exploration. Published cost data and stone recurrence rates were utilized to create a cost-effectiveness decision tree.

RESULTS OBTAINED

Fifty-three (7.1%) were diagnosed with 1HPT. 15 (28%) had hypercalcemia and inappropriately elevated iPTH, 38 (72%) had high normal serum calcium levels and inappropriately elevated iPTH. The potential diagnosis was ignored/missed by primary care physicians in 9 (17.0%) based on a review of prior lab results. Cost modeling was undertaken for 5, 10, 15, and 20-year intervals after screening. Based on our prevalence data, historical risks for recurrence and published cost data for stone treatments, cost savings in screening are realized at 10 years.

CONCLUSION

These results support screening for primary hyperparathyroidism in patients evaluated in a tertiary referral setting.

Translation and Linguistic Validation of the Korean Version of the Wisconsin Stone Quality of Life Questionnaire

Purpose

Although cure rate and efficacy of treatment for urinary stone disease have been improved, clinicians have been indifferent to the quality of life (QoL) of stone patients in Korea. The objective of this study was to develop a Korean version of Wisconsin questionnaire about quality of life questionnaire (K-WISQOL) of stone patients for use in Korea.

Methods

Linguistic validation was permitted for translation by its developers. Three bilingual nonspecialists and 11 panels who were actively involved in treating urinary stone patients performed the translation and linguistic validations. A trained interviewer and 5 Korean patients carried out cognitive debriefing.

Results

Noun words such as “energy” and “responsibilities” were very difficult to translate to Korean. They were substituted by more comprehensive words. After backward translation, translated sentences showed a good agreement with the original WISQOL. During backward translation and the second reconciliation, previously translated Korean version was revised in 5 sentences. In the cognitive debriefing process, all 5 patients thought that these questions explained the patient’s situation well. Most of these respondents answered that explanatory notes of questionnaire were well written and the format of the questionnaire was easy to follow.

Conclusions

The present study demonstrated that, despite language differences, translation and linguistic validation of the K-WISQOL were successfully performed. This K-WISQOL could be useful tools for treatment plan and patient care.

The effect of travel distance on health-related quality of life for patients with nephrolithiasis

INTRODUCTION

Urolithiasis causes a significant impact on health-related quality of life (HRQOL). Patients with kidney stones have high levels of stress and anxiety. Symptom resolution often requires treatment. Travel distance is a barrier to care but little is known about its effects on HRQOL. We hypothesize that increased distance to treatment site is associated with decreased HRQOL.

METHODS

Patients with a history of stones were enrolled at 11 tertiary centers as part of the QOL Stone Consortium of North America. HRQOL data were obtained using the Wisconsin Stone Quality of Life questionnaire (WISQOL). We calculated distance between patient and treatment site using national ZIP codes. We used linear models to evaluate the effect of distance on HRQOL, while also considering demographics data, stones/symptom status, and distance.

RESULTS

Of the 1676 enrolled patients, 52% were male, 86% non-Latino White, and the mean age was 53 years. Mean distance to treatment site was 63.3 km (range 0-3774), with 74% reporting current stones and 45% current symptoms. WISQOL score and distance were negatively correlated for patients reporting current stones and symptoms (p=0.0010). Linear modelling revealed decreased WISQOL scores for patients with symptoms as distance increased from treatment site (p=0.0001), with a 4.7-point decrease for every 100 km traveled.

CONCLUSIONS

Stone disease imposes significant burden on patients' HRQOL due to a variety of factors. Patients with active stone symptoms report worse HRQOL with increased distance to their treatment site. Possible etiologies include travel burden, increased disease burden, decreased healthcare use, and delays in care.

Medical therapy for nephrolithiasis: State of the art

The prevalence of nephrolithiasis is increasing worldwide. Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition. Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance. Insights into occupational exposures and antibiotic use may help uncover individual risk factors. Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.

Quality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS)

Background:

With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire.

Materials and Methods:

Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05.

Results:

103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores.

Conclusions:

Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.

Improving Drainage After Percutaneous Nephrolithotomy Based on Health-Related Quality of Life: A Prospective Randomized Study

PURPOSE

The impact of drainage type after percutaneous nephrolithotomy (PCNL) on the health-related quality of life (HRQoL) has been rarely studied. We conducted a prospective randomized study to evaluate the differences in HRQoL among patients who received different drainage types.

METHODS

A total of 90 patients who underwent PCNL were randomized into three groups to receive a nephrostomy tube (Group 1), a Double-J (JJ) stent (Group 2), and an open-ended ureteral catheter (Group 3) after PCNL, respectively. We compared the perioperative characteristics, surgical outcomes, and HRQoL using Wisconsin Stone Quality of Life (WiSQoL) questionnaire among three groups.

RESULTS

There were no significant differences in patients' characteristics such as age, gender ratio, body mass index, stone burden, and so on. Majority of the surgical outcomes (operative time, estimated blood loss, hemoglobin drop, postoperative complications, and stone-free rate) were also comparable, except for the duration of hospitalization, visual analog scale, and analgesic required. The preoperative WiSQoL scores were similar among the three groups, but significant differences occurred postoperation (Groups 1, 2, and 3, 122.0 vs 105.6 vs 124.4, p < 0.001). Besides, patients in Group 2 had lower willingness (Groups 1, 2, and 3, 86.7% vs 70.0% vs 96.7%, p = 0.02) to undergo the same procedure as future treatment, if needed.

CONCLUSIONS

Our study suggested that the drainage types after PCNL using a nephrostomy tube or a JJ stent or an open-ended ureteral catheter were equally safe and efficacious, but patients who received a nephrostomy tube or an open-ended ureteral catheter had better HRQoL.

A Complete World Literature Review of Quality of Life (QOL) in Patients with Kidney Stone Disease (KSD)

Purpose of Review

The purpose of this study was to review the current evidence for quality of life (QOL) in patients with kidney stone disease (KSD).

Recent Findings

A review of literature from inception to May 2016 for all prospective English language articles on QOL in patients with KSD was done. QOL studies post urological procedures or ureteric stents were excluded. Nine studies (1570 patients) were included of which most (n = 6) used the SF-36 QOL tool. Overall, seven of the nine studies demonstrated a lower QOL in patients with KSD. Bodily pain and general health were significantly lower in patients with KSD compared to their control groups.

Summary

Patients with KSD have an overall lower QOL with most impact on bodily pain and general health domains. Compared to the scale of patients suffering from KSD, more work needs to be done in measuring QOL both in terms of ‘Stone specific’ QOL measuring tools and the quality/number of studies in this field.