Nick Lee et al., 2024: Treatment modalities for small-sized urolithiases and their impact on health-related quality of life
Nick Lee 1 , Patricia Nadeau 1 , Mohamad Baker Berjaoui 2 , Anis Assad 3 , Ben Chew 4 , Kate Penniston 5 , Naeem Bhojani 3
1Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
2Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
3Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
4Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
5University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
Abstract
Introduction: Health-related quality of life (HRQoL) is often reduced in patients with urolithiasis. The objective of this study was to perform a systematic review to describe impact on HRQoL based on different modalities of treatment for small urolithiases with a diameter smaller or equal to 10 mm.
Methods: Electronic databases were searched with no language or date restrictions to identify studies which were included if they reported: adult patients (≥18 years old), renal or ureteral stone(s) confirmed on imagery, validated reporting of HRQoL, and stone diameter equal or smaller than 10 mm undergoing active surveillance, medical expulsive therapy (MET), shockwave lithotripsy (SWL), or ureteroscopy (URS).
Results: Of 672 citations, nine articles were eligible. Five studies (all ureteral) reported HRQoL according to medical stone management. Three of them found that HRQoL in MET patients was better than in active surveillance patients and two studies found no difference in HRQoL between MET and active surveillance groups. Four studies (three ureteral, one renal) reported HRQoL according to surgical stone management. Of the ureteral stone studies, two reported better HRQoL in URS patients than in SWL patients, while one study found no difference between URS and SWL groups. In the renal stone study, SWL patients had better HRQoL than URS patients.
Conclusions: Patients with urinary stones 10 mm or smaller have better HRQoL when treated with MET vs. active surveillance, when treated with SWL vs. URS for renal stones, and when treated with URS vs. SWL for ureteral stones. There is an important need for more studies on this topic.
Can Urol Assoc J. 2024 Apr 2. doi: 10.5489/cuaj.8698. Online ahead of print.
PMID: 38587975 DOI: 10.5489/cuaj.8698 FREE ARTICLE
Comments 1
Solid information on unsound data
One undoubtedly solid information obtained by systemic reviews is easily obtained by looking at the methods- and at the limitations- and conclusion sections of the paper.
“Methods
… search for relevant literature on 4 databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science). The advanced search on these databases included articles from inception to July 2023 …
Limitations
… The heterogeneity of included studies in terms of study design, patient populations, interventions, and reporting of results rendered the possibility of a meta-analysis impossible and presented a limitation regarding the interpretation of the evidence and generalized conclusions of our study. Furthermore, the nature of the included studies brought about several limitations. 1) As the outcomes of HRQOL were self-reported by the participants, they are vulnerable to response bias and recall bias; … 3) lack of the use of a homogenous, standardized, disease-specific scale such as the WISQOL led to heterogeneous reporting of the primary outcome; …
Conclusions
… There is a pressing need for further investigations in this realm, particularly prospective, multi-center, observational studies featuring standardized long-term follow-up and employing a disease-specific instrument like the WISQOL.”
The devastating summary is
within many decades the urological community was not able or willing to collect and publish solid data on what is done in urology viewed from a patient perspective.
See also: Juliebø-Jones P. et al. Front Surg. 2024 Mar 20:11:1374851.
Peter Alken