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 disease-specific quality of life in the short term post-operative period following ureteroscopy (URS) for nephrolithiasis.

Materials

Adults undergoing URS for renal/ureteral stones were eligible for inclusion (10/2020-8/2022). Patients prospectively completed Wisconsin Stone Quality of Life (WISQOL) instrument in-person pre-operatively (POD 0) and via email on POD 30. Scores are reported as a total score and 4 domain scores: social, emotional, disease, and vitality impact. A higher score equates to a better quality of life.

Results

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Total of 178 patients completed enrollment at POD 0 (POD 30, N=67). There were statistically significant improvements for the total score and each of the 4 domain scores between POD 0 and 30 (Wilcoxon rank sum test, all p<0.001) (Figure 1 A-E). On univariate analysis, age (β=0.32; CI: 0.11, 0.53), African American race (β=-11; CI: -20, -2.5), and BMI (β=-11; -1.1, -0.18) were all associated with the total score at POD 0, while only African American race (β=-22; CI: -41, -2.0) remained associated at POD 30. On multivariate analysis, both age (β=0.28; CI: 0.08, 0.49) and BMI (β=-0.67; CI: -1.1, -0.21) remained associated with the total score at POD 0, while no demographic variables were associated with the total score at POD 30 after adjusting for stone and surgical characteristics. A prediction model revealed that only an intraoperative kidney stone location (ref. lower ureter) predicted a profound recovery (>10 points) (OR 0.14; CI: 0.02, 0.87; p<0.035) for the total score.

Conclusion

Ureteroscopy results in significant improvement in disease specific quality of life by 30-days. Both age and BMI may have a modifying influence on recovery. Kidney as opposed to ureteral stone removal may result in a more profound recovery. Results offer meaningful insight to assist in counseling and setting expectation for patients in the post-operative period.

Funding

None

Co-Authors

Jay Fuletra, MD
University of Pennsylvania

Amanda Jones, MD, MPH
University of Pennsylvania

Zili Zong, MS
Children's Hospital of Philadelphia

Jing Huang, PhD
University of Pennsylvania