BERKELEY, CA (UroToday.com) - Urolithiasis has been traditionally thought of as a disease that affects people with discrete stone attacks - an isolated symptomatic event that lasted until the patient was able to pass the stone or received appropriate treatment. Recent studies, however, have explored the ways in which urolithiasis can be looked at as a chronic disease. Patients must often deal with severe pain and nausea, missed work, and multiple trips to the doctor or emergency room. Treatments often require uncomfortable ongoing diet and lifestyle modifications or medications as well as multiple, painful interventions. For some patients, a stone episode may be an isolated event, however, 50% will have a recurrence within 5 years, and for many, recurrences can be much more frequent.
Similar to research on other chronic diseases, with this study we examined how urolithiasis affects quality of life. Using our own novel stone questionnaire as well as a validated measure of health-related quality of life, the SF-36, we demonstrated that stone formers do, in fact, have impaired quality of life, and we have identified the specific disease factors that were most linked to these quality-of-life impairments. Variables such as surgical complications, time from last stone episode, number of emergency room visits, and number of surgeries correlated with the physical and mental SF-36 domains.
Previously we examined the link between depression and urolithiasis, finding depression rates within our stone population significantly higher than the general population. This finding is similar to the higher rates of depression which have been found in many other chronic diseases. We examined the stone disease factors that were most closely tied to depression. A family history of stone disease, a stone episode within the past year, and multiple emergency room visits were all found to be correlated with depression.
Urolithiasis should be viewed as chronic disease with acute exacerbations. Stone disease negatively impacts both physical and mental domains within health-related quality of life, and stone formers are at a higher risk for depression. Knowing the disease and individual characteristics that are linked to poor quality of life and depression can make it easier to identify the patients who are at greatest risk. Practitioners can potentially mitigate modifiable risk factors, provide additional care and empathy when it is needed, and ultimately provide better overall treatment for the patient.
- Angell J, Bryant M, Tu H, et al. Association of Depression and Urolithiasis. Urology 2012; 79: 518.
Michael Bryant as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology and Rollins School of Public Health
Emory University School of Medicine
Atlanta, Georgia USA