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Sahin C et al, 2014: Do the residual fragments after shock wave lithotripsy affect the quality of life?

Sahin C, Tuncer M, Yazıcı O, Horuz R, Cetinel AC, Eryıldırım B, Tarhan F, Sarica K

Dr. Lutfi Kirdar Training and Research Hospital, Urology Clinic, Istanbul, Turkey.
Faculty of Medicine, Urology Clinic, Medipol University, Istanbul, Turkey

Abstract

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 of life. Emergency department visits and colic attacks are the causes of discomfort. Effective stone isintegration by an experienced urologist should be aimed to limit the negative effects of residual fragments on the quality of life evaluation. CONCLUSION: Larger residual fragments could significantly affect the quality of life. 

Urology. 2014 Sep;84(3):549-54. doi: 10.1016/j.urology.2014.05.012.

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Comments 1

Hans-Göran Tiselius on Friday, 24 October 2014 07:41

In this study the QoL was examined in patients with residual fragments. Not surprisingly it was found that patients with residuals measuring ≥4 mm had lower QoL than those with fragments measuring edures. In patients with residuals ymptoms. It is obvious, however, that of patients in that group who did not pass their fragments, at least some also had fragments measuring ≥4mm.

It would have been of interest to know the QoL level in patients rendered stone-free, because it can be assumed that the mere knowledge of being afflicted by a disease that has a 50% recurrence risk also affects QoL.

It is stated, that for patients with residuals, life-long medication with or without dietary modifications means a certain level of emotional burden. In this regard it is important to realize that a stone-free or fragment-free kidney in no way is a guarantee for future freedom of recurrences. Also these patients might have plaques or plugs, not visible on CT examinations. All these patients need recurrence prevention in order to reduce the risk of new stone formation. It is likely that also those patients would experience a reduced QoL.

In this study the QoL was examined in patients with residual fragments. Not surprisingly it was found that patients with residuals measuring ≥4 mm had lower QoL than those with fragments measuring edures. In patients with residuals ymptoms. It is obvious, however, that of patients in that group who did not pass their fragments, at least some also had fragments measuring ≥4mm. It would have been of interest to know the QoL level in patients rendered stone-free, because it can be assumed that the mere knowledge of being afflicted by a disease that has a 50% recurrence risk also affects QoL. It is stated, that for patients with residuals, life-long medication with or without dietary modifications means a certain level of emotional burden. In this regard it is important to realize that a stone-free or fragment-free kidney in no way is a guarantee for future freedom of recurrences. Also these patients might have plaques or plugs, not visible on CT examinations. All these patients need recurrence prevention in order to reduce the risk of new stone formation. It is likely that also those patients would experience a reduced QoL.
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