Presented by: Justin Ziemba MD, MSEd
University of Pennsylvania

Introduction

Urolithiasis is among the most common urological conditions, however, the quality-of-life impact of those with the disease remains significantly understudied, particularly following surgical intervention. We prospectively captured patient-reported outcomes related to pain interference and social participation in the short term post-operative period to better understand the quality-of-life impact of percutaneous nephrolithotomy (PNL).

Materials

Adults undergoing PNL for renal/ureteral stones were eligible for inclusion (10/2020-03/2023). Patients prospectively completed PROMIS—Pain Interference and PROMIS—Ability to participate in social roles and activities instruments in-person pre-operatively (POD 0) and via email on POD 1, 7, 14 and 30. Scores are reported as T-scores (normalized to US pop., mean=50) with a change of 5 (0.5 SD) considered clinically significant and higher score equates to more of the concept being measured.

Results

,

Total of 60 patients completed enrollment at POD 0 (POD 1=15, POD 7=23, POD 14=13, POD 30=17). There were statistically significant differences in pain interference (Figure 1-A) and social participation (Figure 1-B) scores between select point comparisons: POD 0-1 (mean diff. +14.66 pain and -8.81 social; p<0.05), POD 1-14 (mean diff. -12.20 pain and +9.71 social; p<0.05), POD 1-30 (mean diff. -10.43 pain and +9.00 social; p<0.05), and POD 7-30 (mean diff. -10.43 pain and +7.37 social; p<0.05). Black race (β=9.8, CI: 2.1-17.0; p<0.05) and ureteral stone location (β=7.5, CI: 2.3-13; p<0.05) were associated with more baseline pain interference. Increasing age (β=0.60, CI: 0.09-1.1; p<0.05) was associated with greater social participation at POD #1, while female gender was associated with worse social participation at POD #14 (β=-12, CI: -23- -0.83; p<0.05) and more pain interference at POD #30 (β=14, CI: 4.4-24; p<0.05).

Conclusion

Pain interference sharply increases immediately post-operatively, while ability to participate in social roles declines. Patients return to baseline social participation and see resolution of pain interference by POD 14. Results offer meaningful insight to assist in counseling and setting expectation for patients in the post-operative period.

Funding

None

Co-Authors

Amanda Jones, MD, MPH
University of Pennsylvania

Zili Zong, MS
Children's Hospital of Philadelphia

Jing Huang, PhD
University of Pennsylvania