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 - Beyond the Abstract

Traditionally, surgical outcomes after kidney stone surgery have been exclusively focused on “stone-free” status as a way to define success. However, absolute stone-free status is difficult to achieve despite our best efforts, especially when using CT scans for post-operative imaging. Furthermore, definitions of “stone-free” vary in the literature with differing opinions about the fragment size that should be deemed as “clinically insignificant”. With no clear consensus among urologists, determining when to treat asymptomatic residual fragments can be challenging.

In this study, we compared the health-related quality of life (HRQOL) of patients with residual fragments to patients that were rendered stone-free using the Wisconsin Stone Quality of Life (WISQOL) questionnaire after surgical intervention for kidney stones. We determined that residual fragments after surgical intervention are not associated with worse HRQOL as compared to patients who are stone-free after surgery. Repeat surgery solely to render the patient stone-free on imaging may actually be detrimental to patients’ HRQOL. This suggests that surveillance of non-obstructing residual stone fragments may be an acceptable management strategy in certain cases when the patient is not rendered stone-free after the initial surgery.

Since residual fragments can cause significant morbidity or be a nidus for future stone growth, stone-free status following surgical intervention should always remain the ultimate goal. However, when stone-free status is not achieved, we know residual fragments can also remain asymptomatic and stable with appropriate preventative strategies. This symptom heterogeneity underscores the need for inclusion of patient-reported outcomes, such as HRQOL, to help clinicians counsel patients and better guide treatment decisions. Shared decision making is ultimately the key to making appropriate treatment decisions and emphasizes an individualized approach to kidney stone management.

We advocate a paradigm shift in the definition of successful surgical intervention from “stone-free” status alone to a definition that includes optimization of patients’ HRQOL. We acknowledge the limitations of our retrospective cross-sectional study and future well-designed prospective studies with less variability will be necessary to confirm our conclusions. However, our study adds to the growing literature that patient-reported outcomes such as HRQOL should also be taken into consideration.

Written by: Necole M. Streeper, MD,1 & Kristina L. Penniston, PhD2

  1. Division of Urology, Penn State Milton S. Hershey Medical Center; Hershey, PA
  2. Department of Urology, University of Wisconsin School of Medicine and Public Health; Madison, WI

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