Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are standard surgical treatments for intermediate-size (15-20mm) kidney stones but differ in their postoperative recovery, stone-free rates, and complication risks.
We aimed to evaluate what affects patient treatment preferences.
Patients with urinary stone disease completed a choice-based conjoint analysis exercise assessing four treatment attributes associated with URS and PCNL. A sensitivity analysis using a market simulator was performed and the relative importance of each attribute was calculated. Differences in treatment preferences by demographic subgroup were assessed.
A total of 58 patients completed the conjoint analysis exercise. Stone-free rate was the most important treatment attribute while length of hospital stay and cosmesis were less important. Overall, sensitivity analysis based on market simulation scenarios predicted almost equal preference for URS (52.4%) compared to PCNL (47.6%) for treatment of an intermediate-size stone. Older patients (>65 yo) expressed stronger preferences for lower infection rates and shorter hospital stays, and were more likely to prefer URS (67.2%, 95% CI: 52 - 82.5%) compared to younger patients (20-34 yo) (20.3%, 95% CI: 0 - 41.5%) who preferred higher procedure success rates and fewer repeat procedures.
Conjoint analysis predicts nearly equal patient preference for URS or PCNL for the treatment of intermediate-size kidney stones. Older patients prefer the lower UTI risk and shorter hospital stay associated with URS, while younger patients prefer higher stone-free rates associated with PCNL. These results can help guide urologists in counseling patients and improve the shared decision-making process.
Journal of endourology. 2020 Aug 31 [Epub ahead of print]
Kyle Spradling, Hriday P Bhambhvani, Timothy Chan Chang, Alan C Pao, Joseph C Liao, John T Leppert, Blayne Welk, Catherine R Harris, Simon L Conti, Christopher S Elliott
Stanford University School of Medicine, 10624, Urology, 300 Pasteur Drive, Stanford, California, United States, 94305; ., Stanford, California, United States; ., Stanford University School of Medicine, Department of Urology, 300 Pasteur Drive, Suite S287, Stanford, California, United States, 94305; ., Stanford University School of Medicine, 10624, Nephrology, 777 Welch Road, Suite DE, Palo Alto, California, United States, 94304; ., Stanford, Urology, 300 Pasteur Dr., S-287, Stanford, California, United States, 94305-5118; ., Stanford University School of Medicine, Urology, Room S-287, 300 Pasteur Drive, Stanford, California, United States, 94305; ., London, Ontario, Canada; ., Stanford, California, United States; ., Stanford Hospital and Clinics, 10623, Urology, 300 Pasteur Drive, Stanford, California, United States, 94305., Santa Clara Valley Medical Center, 14454, Urology, San Jose, California, United States; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/32867549