Ucer O et al, 2016: Effect of anxiety and pain on success of shockwave lithotripsy (SWL) for treatment of proximal ureteral and renal pelvic stones.
Ucer O, Ceylan Y, Ekren F, Ozan E, Muezzinoglu T.
Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
Urology Clinic, Private Batı Urology Branch Center, Manisa, Turkey.
Department of Psychiatry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
The aim of this study is to evaluate the impact of anxiety and pain on success of shockwave lithotripsy (SWL) for treatment of proximal ureteral and renal pelvic stones smaller than 15 mm. One hundred thirty-two patients with proximal ureteral or renal pelvic stones <15 mm who were treated by a SWL and forty controls were enrolled in the study. State-trait anxiety inventory (STAI) was used to assess anxiety of the controls and patients (before every SWL session). Pains of the patients were measured by a visual analog scale (VAS) at three times (T) of the sessions (T11 at 11 kV, T15 at 15 kV and T end of treatment). The mean STAI scores of the patients at the first SWL session and controls were 40.61 ± 8.71 and 36.11 ± 8.18, respectively (p < 0.05). There was statistically positive moderate relationship between STAI and VAS scores at the first SWL session. The mean size of stone in men and women were 11.16 ± 2.88 and 11.00 ± 3.41, respectively (p = 0.88). In the first session, the mean STAI and VAS scores of the men were significantly lower than the women. The stone-free rate (SFR) of SWL was 72.7 % in this study. The SFR of SWL in the men and women were 78 and 64 %, respectively (p < 0.05). Our data showed that the severity of anxiety and pain in the women were higher than the men. SFR of SWL in the men was higher than the women. The severity of anxiety and pain in the patients may affect SFR of SWL.
Urolithiasis. 2016 Apr 4. [Epub ahead of print]
Years of experience with SWL have convinced me that successful anaesthesia-free SWL is most likely in calm, harmonic and confident patients. Moreover, my impression has been that patients during repeated treatment sessions usually have fewer problems with the treatment, better acceptance and less need of analgesics and sedatives.
In this report some of these observations were also demonstrated statistically. It was thus shown that STAI (state-trait anxiety inventory) score, in addition to the size of the stone influenced the success rate. A higher STAI was recorded for women.
Contrary to my own expectation the authors did not find any different pattern during repeated sessions.
The analysis made differed between patients rendered stone-free (Group 1) and those considered unsuccessfully treated; fragments > 2 mm (Group 2). It had been interesting with a comparison also between those who had disintegrated stones and those who had intact stones.
One problem with interpretation of the treatment outcome was the different characteristics of the stones:
The relevance of the control group is not obvious to me.