Stone size and quality of life: A critical evaluation after extracorporeal shock wave lithotripsy.

OBJECTIVES: To evaluate the quality of life (QoL) of the patients after extracorporeal shockwave lithotripsy (ESWL) on a treated stone size related basis. METHODS: 90 patients undergoing ESWL for kidney stones were divided into three groups; Group 1 (n: 30, ≤ 10 mm), Group 2 (n: 28, 11 mm- ≤ 20 mm) and Group 3 (n: 32, 20- 25 mm). During 3- months follow-up, outcome of the procedure, number of cases with emergency department visits, analgesic required, re-tretatment rates, additional procedures and the changes in the QoL were evaluated. RESULTS: the number of emergency department visits and mean analgesic need; re-treatment rates and additional procedures were significantly higher in Group 3. Evaluation of the QoL scores in three groups showed that cases with larger stone still had lower scores during 3-month evaluation. CONCLUSIONS: Stone size could help us to predict the possible impact of ESWL on the QoL and depending on the size of the stone treated, a well planned indication and effective management possibly by an experienced urologist could limit the changes in the QoL of the patients.

Does metabolic syndrome increase the risk of infective complications after prostate biopsy? A critical evaluation.

PURPOSE: To evaluate the possible association between metabolic syndrome (MetS) and infectious complications after prostate biopsy. METHODS: A total of 480 men underwent prostatic biopsy due to elevated prostate-specific antigen levels and/or abnormal digital rectal examination. Patients were divided into two subgroups with respect to the presence or absence of MetS. Patients in both groups were closely followed with respect to infectious complications after biopsy and the possible effect of MetS as a certain risk factor on these complications was evaluated with a multivariate analysis. RESULTS: Infectious complications were observed in 33 cases (6.8%), while urinary tract infection (UTI) was detected in 30 (6.2%) cases, sepsis occurred in three (0.6%) cases. The percentage of the cases with infectious complications was 11.0 and 3.4% in men with and without MetS, respectively (p = 0.002). These rates were 3.7 versus 1.5%, respectively, for UTI (p < 0.003) and 0.9 versus 0.4%, respectively, for sepsis in both groups (p = 0.594). Multivariate analysis of the data confirmed that MetS was associated with an increased risk of infective complications (odds ratio 3.44 and 95% CI 1.56-7.58, p < 0.002) after this procedure. CONCLUSIONS: MetS could pose a certain increased risk for infectious complications after prostate biopsy. Patients with MetS should be considered as risk cases for this procedure, and they should be evaluated and followed in a very close manner with respect to these complications.

Do the residual fragments after shock wave lithotripsy affect the quality of life?

OBJECTIVE: To evaluate the possible effects of residual fragments on the health-related quality of life in patients undergoing extracorporeal shockwave lithotripsy for renal stones. PATIENTS AND METHODS: Seventy-one patients with residual fragments were divided into 2 further groups; group 1 (n = 42; fragment size, ≤ 4 mm) and group 2 (n = 29; fragment size, >4 mm). During 3-month follow-up, spontaneous passage rates; number of emergency department visits, amount of the analgesic required, additional procedures, and the changes in the quality of life were evaluated. Quality of life was evaluated using the Short Form 36 survey. Statistical analyses included independent sample t tests. RESULTS: Of the 42 cases with fragments ≤ 4 mm, although 92.8% patients passed the fragments spontaneously, fragments resided until 3 months in 4.8% patients. Again, after 2 sessions of extracorporeal shockwave lithotripsy, of the 29 cases with fragments >4 mm, 55% were stone free, whereas 14% still had residual fragments. Mean number of emergency department visit was found to be 0.07 and 0.5 in both groups, respectively. Mean analgesic need was 138.75 mg in group 1 and 375 mg in group 2. Although significantly lower scores were noted only for one parameter during 1-month evaluation in cases with larger fragments, they were present in all 8 parameters during 3-month evaluation. CONCLUSION: Larger residual fragments could significantly affect the quality of life. Emergency department visits and colic attacks are the causes of discomfort. Effective stone disintegration by an experienced urologist should be aimed to limit the negative effects of residual fragments on the quality of life.