WCE 2019: Quality of Life in Stone Formers

Abu Dhabi, United Arab Emirates (UroToday.com) This session was divided into 3 parts discussing quality of life in stone-forming patients. Dr. Kristina Penniston gave an overview of different instruments developed to measure and assess quality of life. Dr. Charles Scales described the use of these instruments in patients with ureteral stents. Dr. Justin Ziemba finished out the session by describing the quality of life changes in patients that undergo stone procedures.

Several instruments have been used to assess quality of life in stone-forming patients. This is an important area, as in some conditions health related quality of life (HRQL) is a more accurate predictor of outcomes than other parameters. The SF36 questionnaire and the EQ5D are both questionnaires that address quality of life at a global level. Since the advent of these instruments, development of specific measures of quality of life have been devised. The ureteral stent symptom questionnaire was the first to be used. A scale specific to pain, PROMIS, was utilized and found to be predictive of requirement of intervention in patients with ureteral stones less than 1 cm. Recently, a questionnaire called the Wisconsin Quality of Life was made using data from patient focus groups. The Cambridge Renal Stone PROM is a questionnaire that looks at dietary changes in addition to other factors. What we know about quality of life diminishment is that it is usually caused by pain and is associated with a higher risk of opioid dependence. Interestingly, quality of life changes appear to vary by demographics and geography.

Dr. Scales described the effect of stent placement on patients’ quality of life. Stents are very commonly placed as part of urologic procedures, as shown by survey-based data in this session. A working model of how stents impact a patients’ quality of life was exhibited. This outlines how there is an unknown underlying physiologic response that leads to bodily manifestations, such as hematuria and pain. This impacts functioning at a physical, mental, and social level, and consequently, work and school performance. Experiencing these issues leads to a change in the patients’ expectations about their own well-being and the requirement of coping behaviors. All of these factors can diminish quality of life. A study was described that showed an 85% decrease in EuroQOL score in stent patients. Alpha blockers have been attempted to relieve stent-related pain and issues, but high-quality data has not proven their efficacy for this indication.

WCE 2019 working model of stent experience

In the final part of this session, Dr. Ziemba provided a detailed analysis of how procedural intervention for stone disease impacts the quality of life. The total number of procedures and the number of URS and PCNL are associated with a decrease in mental composite score, general health perception, and emotional well-being. The number of surgical complications are associated with decreased social functioning. Postoperatively, at 0 months, SWL patients have been shown to have better physical functioning, emotional and physical limitations, social functioning, and mental health scores; however, at 1 month and 6 months, these differences were not present. In summary, Dr. Ziemba mentioned that surgical therapy does improve quality of life dimensions, but the specific surgical technique does not appear to influence improvement.

Presented by: Kristina Penniston, PhD,1 Charles Scales Jr, MD,2  Justin Ziemba, MD3

1. University of Wisconsin- Madison, School of Medicine and Public Health, Madison, Wisconsin 
2. Duke University Medical Center, Durham, North Carolina
3. University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania