ORLANDO, FL USA (UroToday.com) - Urolithiasis is a highly morbid condition with significant pain/discomfort and common recurrence among patients.
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This study attempted to “compare self-reported anxiety, depression, fatigue, pain interference, physical function, satisfaction in social roles, and sleep disturbance in patients with urolithiasis compared to age and gender-matched U.S. population norms.” The authors used the PROMIS-43, an NIH-sponsored online data system designed for chronic disease, which uses validated questionnaires to evaluate quality of life.
The study administered questionnaires performed on patients of the kidney stone clinic. Information collected included stone history (procedures, stone passage, pain, dietary and medical treatments) and demographic information (age, gender, whether primary income earner or caregiver, and presence of other chronic illnesses), and the PROMIS-43 questionnaire. PROMIS subject domains include: depression, anxiety, physical function, pain interference, and fatigue. Results were analyzed using gender and age matched groups for the general U.S. population, while scores were reported as a percent. The general population mean was set at 50% with a standard deviation of 10%.
Of the 100 patients who completed the survey, 36% were male (average age 52 years), 58% were primary income earners, and 35% were primary caregivers for children. 38% had never passed a stone, while 17% passed 10 or more stones in their lifetime. 67% of patients had at least one ureteral stent, and 87% had at least one stone removal procedure. The overall treatment rates were as follows: 45% had shockwave lithotripsy, 51% ureteroscopy, and 30% percutaneous nephrolithotomy. Each subject received an average of 2.4 procedures. Compared to controls, urolithiasis patients had greater pain (53%, p < 0.001), lower physical function (47%, P < 0.005), and lower depression (47.5%, p < 0.005) — but no difference in anxiety, fatigue, or sleep disturbance. Patients with a history of having passed 10 or more stones had significantly worse pain interference and depression.
Urolithiasis patients unsurprisingly report worse pain and physical function compared to the general population, as we would expect for a population with greater disease burden, however, it is surprising to note that they have less depression. The authors suggest that this may be due to selection bias among patients motivated to cure their disease. Understandably, the impact of pain on quality of life was greatest in those patients who had passed more than 10 stones in their lifetime, underscoring the importance of preventive measures. The also suggest that the PROMIS-43 measure is appropriate for use in the nephrolithiasis population.
Presented by Robert Brown at the American Urological Association (AUA) Annual Meeting- May 16 - 21, 2014 - Orlando, Florida USA
Glickman Urological and Kidney Institute, Cleveland Clinics, Cleveland, OH USA
Written by Eric Ballon-Landa, BA, University of California (Irvine), and medical writer for UroToday.com