Stephens E. et al., 2023: Does quality of life in patients undergoing shock wave lithotripsy change with repeat procedures: a prospective pilot study from a teaching hospital
Stephens E, Pietropaolo A, Tear L, Davis T, Joshi HB, Somani BK.
Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
School of Medicine, Cardiff University, Cardiff, United Kingdom; Department of Urology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
Introduction: Shock wave lithotripsy (SWL) is a well-established treatment for kidney stone disease (KSD) and despite its decreased popularity in the past, it has now gained renewed interest due to its minimally invasive nature and good outcomes, especially in the face of COVID-19 pandemic. The aim of our study was to perform a service evaluation to analyse and identify quality of life (QoL) changes [using Urinary Stones and Intervention Quality of Life (USIQoL) questionnaire] after repeat SWL treatments. This would enable a greater understanding of SWL treatment and reduce the current gap of knowledge regarding patient specific outcomes in the field.
Material and methods: Patients affected by urolithiasias underwent SWL treatment between September 2021 and February 2022 (6 months), were included in the study. A questionnaire was given to the patients in each SWL session and consisted of three main topic areas: a domain on Pain and Physical Health, on Psycho-social Health and on Work (see appendix below). Patients also completed a Visual Analogue Scale (VAS) in relation to the pain related to the treatment. Data from the questionnaires were collected and analysed.
Results: A total of 31 patients filled in two or more surveys, with a mean age of 55.8 years. On repeat treatments, pain and physical health domain was significantly better (p = 0.0046), psycho-social health domain was significantly better (p <0.001), work domain was significantly better (p = 0.009) and a correlation [on Visual Analog Scale (VAS)] was observed between pain decreasing in subsequent SWL procedures.
Conclusions: Our study found that the choice of SWL to treat KSD does improve a patient's QoL. This could be related to improvement of physical health, psychological and social wellbeing, and ability to work. Higher QoL and low pain scores are observed in relation to repeat SWL treatment and are not directly associated to stone-free status.
Cent European J Urol. 2022;75(4):399-404. doi: 10.5173/ceju.2022.189. Epub 2022 Nov 10. PMID: 36794027. FREE ARTICLE
Today, there are few articles that present positive data on shock wave lithotripsy, despite the enormous success that has been associated with this non-invasive treatment modality. The present report has its focus on QoL after SWL for stones in the kidney. The pain experience was significantly reduced, and improvements were recorded also for the domains of psychosocial health and work.
Interestingly pain experience as well as QoL were further improved during the second treatment session. The increased QoL supports the advantage of SWL for stones both in the kidneys and in the ureters. Most interestingly is the observation that QoL was unrelated to the stone-free rate.
It is mentioned in the article that the psychological effect is important, but more likely is it that disintegration of stones albeit not necessarily leading to a stone-free state, is of fundamental importance for reduced pain experience. Thus, it seems likely that stone disintegration and not necessarily stone-free status was the cause of improved well-being. Reduced stone burden apparently decreased pain and discomfort.