Hamamoto S et al, 2017: Determinants of health-related quality of life for patients after urinary lithotripsy: ureteroscopic vs. shock wave lithotripsy.
Hamamoto S, Unno R, Taguchi K, Naiki T, Ando R, Okada A, Inoue T, Okada S, AbdelRazek M, Kohri K, Yasui T; SMART Study Group.
Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
Department of Urology, Toyota Kosei Hospital, Toyota, Aichi, Japan.
Department of Urology, Kansai Medical University Medical Center, Osaka, Japan.
Department of Urology, Gyotoku General Hospital, Chiba, Japan.
Department of Urology, Qena University Hospital, Qena, Egypt.
PURPOSE: To compare the longitudinal health-related quality of life (HRQoL) after surgical intervention with ureteroscopic lithotripsy (URSL) and shock wave lithotripsy (SWL) and to evaluate the factors affecting HRQoL in urolithiasis patients.
METHODS: A total of 262 patients who underwent lithotripsy (SWL, n = 61; URSL, n = 201) for upper urinary tract calculi treatment between June 2012 and January 2015 were evaluated. All patients were administered the Short-Form 36-item survey (SF-36) to assess HRQoL at four timepoints: before surgery, on the day of discharge, and 1 and 6 months after lithotripsy. Stone-free rates, complications, and analgesic requirements were evaluated to compare the effects of the two procedures on HRQoL.
RESULTS: At the day of discharge, patients in the URSL group had significantly lower mean scores on five different subscales of the SF-36 questionnaire, namely, physical functioning, role-physical, social functioning, role-emotional, and mental health. The stone-free rate at 3 months after lithotripsy was significantly lower in the SWL group (72.1% vs. URSL, 93.0%; p < 0.001). The hospital stay was shorter in the SWL group (2.1 ± 0.07 vs. URSL, 4.1 ± 0.13 days; p < 0.001), and the analgesia requirements were also lower in the SWL group (0.3 ± 0.08 vs. URSL, 0.9 ± 0.20; p < 0.001).
CONCLUSIONS: The post-lithotripsy HRQoL was superior for SWL compared to URSL on the discharge date despite the lower stone-free rate of the former. The longer hospital stay and higher postoperative pain appeared to be the determinants of the lower HRQoL in the URSL group.
Urolithiasis. 2017 Mar 29. doi: 10.1007/s00240-017-0972-3. [Epub ahead of print]
ESWL is better than URS!? Comparing the present data with those of other previously reviewed publications (e.g. Sahin et al. Stone size and quality of life: A critical evaluation after extracorporeal shock wave lithotripsy. Arch Ital Urol Androl. 2015 Sep 30;87(3):227-32) they do not match.
The problem of evaluating HRQoL with general tools like the SF-36 is that the latter are not specific for urolithiasis and the results may reflect other health conditions than that of urolithiasis.
The interested reader is referred again to publications of Kristina Penniston and the recently validated stone-specific Wisconsin Stone Quality of Life Questionnaire (Penniston KL et al. Validation and Reliability of the Wisconsin Stone Quality of Life Questionnaire.J Urol. 2017 May;197(5):1280-1288)