Comparison of the Effects of Four Treatment Techniques Commonly Used in Ureteral Stone Treatment on Patients' Daily Physical Functioning: An Observational Randomized-Controlled Study

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.

Quality of life after urinary stone surgery based on Japanese Wisconsin Stone Quality of Life questionnaire: multicenter analysis from SMART study group

We aimed to evaluate the impact of surgical treatment for urinary stones on perioperative health-related quality of life (HRQOL) using the Japanese Wisconsin Stone Quality of Life questionnaire (J-WISQOL), an HRQOL measure designed for patients with urinary stones. This study prospectively enrolled 123 patients with urinary stones who visited three academic hospitals for stone treatment. The participants completed the J-WISQOL within 4 weeks before and after the urinary stone treatment. Treatments included shock wave lithotripsy (SWL), ureteroscopy lithotripsy, and endoscopic combined intrarenal surgery. J-WISQOL was assessed for age, stone size and location, type of treatment, stone-free status, postoperative ureteral stent placement, hospital stay, and complications in all patients. Patients with stones in the ureter had significantly greater social impact D1 and disease impact D3 than those with stones in the kidney. In a comparison of pre- and postoperative J-WISQOL, patients without postoperative ureteral stent placement scored significantly higher on social impact D1 and disease impact D3. Patients with shorter hospital stays had significantly higher social impact D1 and disease impact D3 (p < 0.001) than those with longer hospital stays. SWL significantly improved the total score, social impact D1, and disease impact D3 compared with other treatments. Perioperative HRQOL in patients with urinary stones is particularly affected by the type of treatment, ureteral stent placement, and hospital stay, which should be considered in surgical selection and patient decision-making.

The study of double-J stent free mode of flexible ureteroscopy and laser lithotripsy: a single centre experience

OBJECTIVE

To evaluate the effectiveness and safety of flexible ureteroscopy in the treatment of kidney and upper ureteral calculi under double-J stent free mode.

METHODS

Data from patients who underwent flexible ureteroscopy and laser lithotripsy between February 2018 and September 2021 were retrospectively and analysed. Cases were grouped according to pre- or postoperative use of the double-J stent (6 Fr): Post-F group (preoperative double-J stent but no postoperative double-J stent); Pre-F group (no preoperative stenting but with postoperative double-J stent); and Routine group (preoperative and postoperative double-J stenting).

RESULTS

A total of 554 patients (390 male and 164 female) were included. The mean operation time was similar between the three groups, with no statistically significant difference. Incidence of grade 0-1 ureteral injury was significantly higher in the Pre-F group versus other groups, but there were no significant between-group differences in other operation-related complications. During follow-up, stent-associated complications were observed in the Pre-F and Routine groups, but not in the Post-F group. Stone clearance rates were similar between all groups at 1, 3 and 6 months following surgery.

CONCLUSIONS

Flexible ureteroscopy using double-J stent free mode was found to be safe, feasible and effective in treating renal and upper ureteral calculi.

Comparison of flexible ureteroscopy in the treatment of 1-2 cm single nephrolithiasis and multiple nephrolithiasis

Objective

To compare the efficacy of flexible ureteroscopy for single urinary stones with that of multiple urinary stones.

Methods

A retrospective study was conducted on patients who underwent flexible ureteroscopy in Qilu Hospital of Shandong University from January 2016 to March 2021. Propensity score matching was used to match patients with no statistical difference in preoperative clinical data, and they were divided into solitary calculi and multiple calculi two groups. The postoperative hospital days, operation time, complications and stone free rate were compared between the two groups. And multiple stones were divided into high group (S-ReSc > 4) and non-high group (S-ReSc ≤ 4) for analysis.

Results

313 patients were counted. After propensity score matching, 198 patients were finally included in the study. There were 99 cases in the solitary stone group and the multiple stone group. There were no significant differences in postoperative hospital days, complications and stone free rate between the two groups. The operation time of patients with solitary stone group was significantly shorter than that of patients with multiple stones (65.00 min, 45.00 min VS 90.00 min, 50.00 min, P < 0.001). The SFR of high group in the multiple stones group was significantly lower than that in the non-high group (7, 58.3% VS 78, 89.7%, P = 0.013).

Conclusion

Despite the longer operation time, flexible ureteroscopy has similar outcomes in the treatment of multiple (S-Rec ≤ 4) compared to solitary calculi. Although, this doesn't apply when S-ReSc > 4.

Safety and efficacy of extracorporeal shock wave lithotripsy vs. flexible ureteroscopy in the treatment of urinary calculi: A systematic review and meta-analysis

Objective

This study aims to compare the safety and efficacy of extracorporeal shock wave lithotripsy (SWL) and flexible ureteroscopy lithotripsy (f-URS) in treating urinary tract stones.

Methods

We systematically searched PubMed, Embase, and Cochrane for literature comparing SWL with f-URS. The primary outcomes we focused on were stone-free rate (SFR) and complications; the secondary outcomes were operation time, hospital stay, retreatment rate, number of sessions, and auxiliary procedures rate. We used ReviewManager version 5.4.1 and STATA version 14.2 for meta-analysis.

Results

Seventeen studies with a total of 2,265 patients were included in the meta-analysis, including 1,038 patients in the SWL group and 1,227 patients in the f-URS group. The meta-analysis indicated that patients in the f-URS group had higher SFR than those in the SWL group [odds ratio (OR): 2.00, 95% confidence interval (CI): 1.29-3.12, p = 0.002]. In addition, we found no significant difference in complications (OR: 1.08, 95% CI: 0.85-1.37) between the two treatments. Also, we found that the retreatment rate and the auxiliary procedure rate in the f-URS group were significantly lower than those in the SWL group (OR: 0.08, 95% CI: 0.02-0.24, p < 0.00001; OR: 0.30, 95% CI: 0.11-0.83, p = 0.02). Moreover, the number of sessions in the f-URS group was significantly lower than that in the SWL group [mean difference (MD): -1.96, 95% CI: -1.55 to -0.33, p = 0.003]. However, the operation time and hospital stay in the f-URS group were significantly longer than those in the SWL group (MD: 11.24, 95% CI: 3.51-18.56, p = 0.004; MD: 1.14, 95% CI: 0.85-1.42, p < 0.00001).

Conclusion

For 1-2-cm urinary stones, f-URS can achieve a higher SFR than SWL while having a lower retreatment rate, number of sessions, and auxiliary procedure rate. For urinary stones <1 cm, there was no significant difference in SFR between SWL and f-URS groups. The SWL group has a shorter operative time and hospital stay than the f-URS group.

Validation of The Japanese Version of The Wisconsin Stone Quality of Life Questionnaire (WISQOL): Results from SMART Study Group

BACKGROUND

The Wisconsin Stone Quality of Life questionnaire (WISQOL) is a health-related quality of life measure designed for patients with urinary stones. It has been translated and used in several languages. This study aimed to validate the Japanese version of the WISQOL (J-WISQOL).

MATERIALS AND METHODS

The J-WISQOL was translated and validated using a multistep process proposed by the World Health Organization that involved forward translation, back-translation, and pilot testing with a group of patients. This study enrolled 150 patients with urinary stones who visited three academic hospitals for stone treatment. We assessed convergent validity of correlation patterns and internal consistency of the J-WISQOL and Short-Form 36-item survey version 2 (SF-36v2).

RESULTS

Overall, 150 patients were enrolled. The mean total score of the J-WISQOL was 108.18 ± 20.26 (raw score min-max, 28-140), suggesting that the onset and symptoms of urinary stones reduced the health-related quality of life in the patients. The J-WISQOL showed good internal consistency (Cronbach's α = 0.96) and inter-domain associations (Spearman's correlation coefficient r = 0.67-0.94). The J-WISQOL was correlated with the SF-36v2 in all domains: social, emotional, health, and vitality impact (r = 0.47-0.66).

CONCLUSION

The J-WISQOL is a reliable instrument for evaluating health-related quality of life measures in patients with urinary stones. It could be a useful quality of life questionnaire for urinary stones in Japan.