Validated Methods of Assessing Quality of Life in Stone Disease.

PURPOSE OF REVIEW: With the emphasis on quality standards when determining reimbursements rates, patient reported outcomes are now of particular interest to clinicians. This review addresses health-related quality of life (HRQOL) detriments that have been studied in patients with stone disease. RECENT FINDINGS: Several instruments been validated for use in stone formers. Previously, generic instruments revealed decreased HRQOL in urolithiasis patients. Recently, a disease-specific tool has been developed and has provided more insight into the specific symptoms that negatively affect the patient experience. Evidence now reveals lower HRQOL in both symptomatic and asymptomatic patients with calculi, as well as varying determinants after certain interventions. Disease-specific tools have been shown to be more sensitive to urologic-related complaints. These findings should be considered in management decisions to allow for patient-centered care. Further application and standardization of these assessment tools into prospective studies may have value in refining current treatment guidelines.

Role of Spiritual Sentiments in Improving the Compliance of Water Intake in Patients with Urolithiasis.

The aim of this study was to compare the compliance for water intake and rate of recurrence between spiritually motivated and non-motivated patients of renal tract stone disease. It is a multi centric prospective cohort study, conducted in Department of Urology, Institute of Kidney Diseases and Peshawar Medical College, from January 10, 2009 to December 2012. A total of 180 patients with comparable demographic, IQ, EQ and BMI after achieving complete stone clearance were divided into two equal groups. Both groups were instructed to increase the water intake timetable according to AUA guidelines. Group 'A' comprising of 90 patients who were identified as spiritually motivated patients based on questioner of FICA 12 is also instructed that increasing the water intake is mentioned in contemporary Islamic medicine. No spiritual instruction was given to Group B. The instructed guidelines and practice for amount and timing of water intake were recalled from participants at the end of 6 and 12 months. The data were recorded on structured proforma and was analyzed using SPSS version 17. The mean age of the patient in Group A was 37.5 years (18-70 years), while in Group B it was 34 years (18-65 years). Urolithiasis affected predominantly male gender in both groups. Sixty-five patients (72.2 %) in Group A have significant compliance (p < 0.001) for water intake over Group B (46 %). The spiritually motivated Group A has significantly reduced rate of recurrence of stones in 23 patients versus 37 in Group B. The spiritually motivated patients had significantly better compliance for water intake and reduced rate of recurrence versus non-motivated individuals in urolithiasis.

Patient-Reported Outcomes Measurement System (PROMIS®) for Patients with Urolithiasis: Initial Report.

PURPOSE: Health related quality of life is increasingly important in quality improvement efforts for medical conditions. However, it has proved challenging to measure health related quality of life for urolithiasis, given the distinct chronic and acute phases of this disease. We evaluated the use of PROMIS® (Patient-Reported Outcomes Measurement System) to assess the patient experience through acute stone episode stages. MATERIALS AND METHODS: PROMIS pain measures (intensity and interference) were obtained from patients at a subspecialty kidney stone clinic. Four types of clinical encounters were considered, including emergency department followup, trial of passage, stent removal and 1-month postoperative findings. Raw scores were translated into population normed T-scores with a T-score of 50 considered the reference population mean and a score of 60 considered 1 SD above the mean. T-scores were compared across encounter types on univariate and multivariate analysis. RESULTS: A total of 2,018 complete surveys were available from 1,162 patients. Mean pain intensity and pain interference T-scores differed significantly by encounter type (p <0.001). On multivariate analysis the OR of T-scores greater than 60 was higher for pain intensity and interference for all encounter types relative to postoperative findings, including emergency department followup 37.9 vs 124.9, passage trial 5.4 vs 10.5 and stent removal 9.4 vs 30.2 (p <0.001). Additionally, female gender and younger age were independent risk factors for T-scores greater than 60. CONCLUSIONS: PROMIS pain measures are responsive to the phase of care during symptomatic stone events. Further application of this instrument holds great potential as a valuable tool to improve the quality of urolithiasis care.

Quality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS).

BACKGROUND: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire. MATERIALS AND METHODS: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05. RESULTS: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores. CONCLUSIONS: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.

Treatment expectations and health-related quality of life in stone formers.

PURPOSE OF REVIEW: The objective of this article is to address patients' expectations of stone treatment - both surgical and medical - and their health-related quality of life (HRQOL). We present a rationale for greater inclusion of measures to assess patient expectations, satisfaction, and HRQOL into surgical and medical management for patients with recurrent urolithiasis. RECENT FINDINGS: Patients' treatment expectations and HRQOL are fundamental and progressive new areas of interest in urolithiasis. Patients whose treatment regimens result in outcomes that match their expectations are likely to be more satisfied, which may influence their HRQOL, a valid and valuable outcome of any medical treatment or procedure. Patient perceptions of treatment effects for stones, whether surgical or medical, are complex and may not reflect only stone-free rates, surgical complication rates, and side-effects, the outcomes of traditional interest in urology. SUMMARY: If we understand the issues of most importance to our patients, we can provide appropriate information and education that ensures the most realistic expectations, minimizes disappointment and risk, and contributes most to the patients' HRQOL.

[Psychophysiological determinants of perception of quality of life of gerontological patients with urolithiasis].

The analysis of psychophysiological determinancy perception of life quality of gerontological patients with urolithiasis. The study was performed on 108 patients aged 60 to 76 years (51men, 57women). In order to determine the psychophysiological phenomenology of life survey was selected - before surgery, during the severe clinical manifestations of the disease. Research Methods «integrative anxiety test¼ (ICT 1997), «type attitude to the disease¼ (Tobol, 1987), total questionnaire WHOQOL-100. Types relationship to disease, in which anxiety is not significantly improved due to illness, causes higher levels of QOL (86,4±2,69) compared to the level of 70,1±4,28 points (p<0,001, r=-0,35) corresponding types of response in the presence of high anxiety. The presence of trait anxiety levels decreased quality of life in both sexes. In men, there was the highest level of determinism of the quality of life of their independence and physical ability; women - social relations and spiritual sphere. The lowest indicators of quality of life were observed in women and in patients with acute onset and complicated urolithiasis.

Natural history and quality of life in patients with cystine urolithiasis: a single centre study.

OBJECTIVE: To describe the natural history and quality of life (QoL) in patients with cystine urolithiasis. PATIENTS AND METHODS: A cohort study was carried out involving participants recruited from a single surgeon's case mix. Patients with cystinuria and related urolithiasis were invited to complete a questionnaire involving demographic information, use of medical treatment, surgical interventions and the 36-item short-form 36-item short-form health survey (SF-36). RESULTS: In all, 14 patients completed the survey. The SF-36 survey showed lower QoL than the general public in seven of eight domains. The mean interventional rate in patients with cystinuria was 10.6 procedures per patient. Most patients reported previous use of d-penicillamine and urinary alkalinisation medications, with most ceasing due to side-effects or lack of perceived efficacy. CONCLUSION: Cystinuria is associated with a high rate of surgical intervention and lower QoL than the general public. Individuals with this condition report that medical management is either ineffective or poorly tolerated. There is a need for further improvements in medical management of cystinuria, to reduce the rate of operative intervention.

Increased risk of anxiety among patients with urolithiasis: A nationwide population-based cohort study.

OBJECTIVES: To investigate whether patients with urolithiasis are at an increased risk of anxiety and depression. METHODS: We used universal insurance claims data in Taiwan from 2000 to 2011 to identify patients with newly diagnosed urolithiasis (n = 32 617) and those without urolithiasis (n = 130 465). Incidences, hazard ratios, and incidence rate ratios of anxiety and depression were determined in both cohorts in terms of baseline demographic characteristics and comorbidities until December 2011. RESULTS: The urolithiasis cohort yielded a higher incidence of anxiety (11.9 vs 6.91 per 1000 person-years) with an adjusted hazard ratio of 1.5 (95% confidence interval 1.42-1.57) than the non-urolithiasis cohort. The urolithiasis cohort also showed a higher incidence of depression (5.79 vs 3.95 per 1000 person-years) with an adjusted hazard ratio of 1.26 (95% confidence interval 1.18-1.35) than the non-urolithiasis cohort. Regardless of the patients' baseline comorbidities, patients with urolithiasis showed a higher incidence rate ratio of anxiety and depression than those without urolithiasis (with no comorbidities: adjusted hazard ratio 1.62, 95% confidence interval 1.49-1.76] for anxiety and adjusted hazard ratio 1.37, 95% confidence interval 1.23-1.54 for depression). CONCLUSION: Urolithiasis is recurrent, and significantly associated with anxiety and depression. Therefore, urologists should diagnose patients suspected with this disease and provide proper medical care.

Health related quality of life for stone formers.

PURPOSE: Urolithiasis is a common urological condition that causes significant pain and suffering. Until recently few studies had been done to examine how quality of life is affected in stone formers. We hypothesized that patients with multiple recurrent episodes of urolithiasis have worse health related quality of life. Thus, we identified specific factors that impact health related quality of life in patients with urolithiasis. MATERIALS AND METHODS: In an institutional review board approved study we recruited 386 patients through mailings and through the outpatient clinic who were evaluated at our institution for urolithiasis in the last 5 years. Each patient was asked to answer questionnaires on stone disease, including SF-36®, a validated 36-item health care quality of life survey. RESULTS: Of the 386 patients recruited for study 115 responded to our inquiry. Variables such as surgical complications, time from last stone episode, number of emergency room visits and number of surgeries correlated with the SF-36 domains. CONCLUSIONS: Urolithiasis is associated with severe physical and psychological effects that lead to clinically significant impairment in quality of life. Our findings confirm and expand the findings of previous groups showing the many ways in which stone formation can affect patient quality of life. Appreciation of these effects in the acute and chronic treatment settings may change the way that the disease is approached.

[Quality of life in patients with urolithiasis depending on methods of drainage of the upper urinary tract].

A sociological study was made of quality of life of 60 patients with nephrostomic drainage and 71 patients with an ureteral stent according to standard international questionnaires SF-36 and EORTC QLQ-C30, version 3.0. It was found that both internal and external drain significantly aggravate quality of life in the same degree. Younger patients of both groups suffered less. Quality of life was higher in both groups in drainage duration up to 1 month (p < 0.05), in 1 to 6 month draining quality of life is worse in both groups. Internal drainage is worse tolerated by males aged 25-44 years and elderly women aged 60-75 years, especially in long-term drain (over 6 months). Internal drainage is worse tolerated by elderly females (60-75 years of age) and senile women (over 75 years) in 6 month and longer drainage. The study of large number of patients revealed significant differences in quality of life in patients with nephrostomic drain and ureteral stent.

Health related quality of life differs between male and female stone formers.

PURPOSE: Chronic urolithiasis often results in long-term health complications, frequent clinic visits, multiple interventions and disruptions to patients' lives. While the most valued treatment end point has been stone-free status, patient health related quality of life should also be considered. Little is known about health related quality of life in stone formers. We characterized the health related quality of life of stone formers at our institution. MATERIALS AND METHODS: After institutional review board approval all adult stone formers treated at our Metabolic Stone Clinic from 1995 to 2006 were invited to participate. Of these patients 189 (36%) completed the SF-36v2 Health Survey, a validated, 36-item, generic health and well-being questionnaire addressing physical, social and emotional domains. Comparisons of scores were made with those of U.S. norms and within-sample for demographic and clinical variables. Statistical analyses included independent sample t tests and ANOVA. RESULTS: Compared to healthy adults, stone formers reported lower health related quality of life for general health (64.9 +/- 1.6) and bodily pain (69.4 +/- 1.6), and women reported greater impairment (61.4 +/- 2.4 and 66.5 +/- 2.4, respectively). Comorbidities such as depression, diabetes, hypertension and overweight/obesity contributed to lower scores for many health domains. CONCLUSIONS: The health related quality of life of stone formers, especially women, is compromised compared to U.S. norms. Women stone formers scored lower than men for physical and mental health. Clinicians should be aware of the risk of impaired health related quality of life in stone formers. A new and promising end point in the management of urolithiasis is improvement of health related quality of life. Studies that identify treatment strategies that maintain or improve health related quality of life for individual patients are warranted.

Impact of stone disease: chronic kidney disease and quality of life.

This article reviews the impact of stone disease on chronic kidney disease and renal function; evaluating the natural progression of disease as well as the impact of surgical interventions. The impact of stone disease, medical therapy, and surgical therapy for stones on quality of life is discussed.

Chronic stress and calcium oxalate stone disease: is it a potential recurrence risk factor?

Chronic emotional stress is associated with increased cortisol release and metabolism disorders. However, few studies have evaluated the influence of chronic stress on calcium oxalate (CaOx) stone disease and its recurrence. A total of 128 patients were enrolled in this case-control study over a period of 20 months. All patients were CaOx stone formers with a recent stone episode (<3 months); 31 were first-time stone formers (FS) and 33 recurrent stone formers (RS). Dimensions of chronic stress were evaluated with self-reported validated questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout and satisfaction with life. An ad hoc self-reporting questionnaire was designed to evaluate stress-related specifically to stone episodes. Blood and urine samples were collected to determine cortisol levels and urinary composition. In addition, epidemiological data, socioeconomic information, diet and incidences of metabolic syndrome (MS) were reported. Overall, no significant differences were observed in the scores of cases and controls on any of the questionnaires dealing with stress. The number (p < 0.001) and the intensity (p < 0.001) of perceived stressful life events were higher in RS than in FS, but there were no differences between the two groups in other dimensions of stress. RS had higher glucose (p = 0.08), uric acid (p = 0.02), blood cortisol (p = 0.01), and urine calcium levels (p = 0.01) than FS. RS also had lower economic levels (p = 0.02) and more frequent incidences of MS (p = 0.07) than FS. Although no differences were observed in cases and controls among any dimension of chronic stress, the number and intensity of stressful life events were higher in RS than in FS. These differences correlate with variations in blood and urinary levels and with metabolic disorders, indicating an association between chronic stress and risk of recurrent CaOx stone formation.

Association of depression and urolithiasis.

OBJECTIVES: To study the hypothesis that patients with urolithiasis would have a higher prevalence of depression compared to the general population. Urolithiasis is associated with frequent recurrences. Patients with urolithiasis may develop a chronic condition associated with poor quality of life and depression. The frequency and severity of stones episodes would relate to depression. METHODS: In an institutional review board-approved study; we prospectively recruited 115 patients who were evaluated for urolithiasis. Patients completed an Emory stone questionnaire covering demographics and a validated CES-D depression questionnaire. Depression scores were compared with U.S. norms. Demographics and clinical variables were analyzed. RESULTS: On the CES-D depression questionnaire 30.4% of patients scored ≥ 16, a "significant level of physiological distress." The U.S. lifetime prevalence of depression was 16.5%. Determinants of depression included the following: family history of urolithiasis (OR = 3.49, CI = 1.51; 8.07), stone episode within the last 12 months (OR = 2.77, CI = 1.18; 6.53), and >1 emergency room visits for stone disease (OR = 2.61, CI = 1.14; 5.99). Patients with Charlson comorbidity indexes of ≤ 1 were more likely to be depressed than those scoring >1 (OR 2.89, CI = 1.20; 6.95). There were no significant associations with age at first stone, number of lifetime stones, number of surgeries, number of workdays missed, and need for dietary modifications or medications for stone prevention. CONCLUSIONS: The prevalence of depression in our patient cohort with urolithiasis was substantially greater than societal norms. Multiple stone-related factors were associated with significant psychological distress. Appreciation of this issue may allow better patient care.

Quality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS)

ABSTRACT Background: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire. Materials and Methods: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05. Results: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores. Conclusions: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.