How do the residual fragments after SWL affect the health-related quality of life? A critical analysis in a size-based manner

Abstract

This study aimed at evaluating the possible effects of residual fragments (RF) after shockwave lithotripsy (SWL) on the health-related quality of life (QOL) of the patients on a size-related basis. Eighty six patients with RF after SWL were divided into three groups: Group 1 (n:30 with fragments ≤ 2 mm), Group 2 (n:21 2-≤ 4 mm) and Group 3 (n:35 > 4 mm). During a 3-month follow-up, spontaneous passage rates, emergency department visits, mean analgesic required, additional procedures and the QOL were all evaluated. QOL was evaluated using the Short Form-36 survey. Of the 30 patients with fragments ≤ 2 mm all cases passed the fragments spontaneously. Of the 21 cases with fragments 2-≤ 4, however, 76% were stone free. Last, of the 35 cases with fragments >4 mm, 52% passed them spontaneously in 3 months. While no patient with fragments ≤ 2 mm required emergency department visit, 19% of the cases with fragments 2-≤ 4 mm and 51.4 % with fragments >4 mm did require this visit. Mean analgesic need (mg) values were higher in cases with larger fragments. Evaluation of the QOL score data in a subgroup comparison base showed that cases with larger fragments had prominently lower scores during both 1- and 3-month evaluation. RF after SWL could pose an impact on the QOL of the cases in a size-related basis. While fragments ≤ 2 mm had nearly no impact on this aspect larger fragments could significantly affect the QOL.

Comparative Analysis of Shock Wave Therapy Success Rate in Management of Renal Stones and Patient Anxiety

“…In this respect, the relationship between SWL procedure and quality of life has been investigated in several studies. [3,[14][15][16] Conclusion drawn from these studies may be summarized as physicians responsible for treatment of stones in the urinary system should not focus only on the rate of stonefree status obtained, and should also take into account possible affect on patients' social and economic status and their quality of life of the treatment administered. More invasive procedures performed following initial procedure in order to increase the rate of stone-free success may negatively affect patients' quality of life and cause increased anxiety.…”

Treatment modalities for small-sized urolithiases and their impact on health-related quality of life

“…In individuals undergoing SWL, the presence of residual fragments, particularly those exceeding 2mm, can also exert significant effects on HRQOL. 24 Encouraging patients to actively participate in decisions regarding stone treatment is crucial. Patient decision-making aids have proven to enhance patients' understanding of various surgical options for ureteral stone removal.…”

Advances in urology 2015–2016

“…Patients with larger fragments had greater requirements for analgesia and had lower QoL scores at 1 and 3 months. 63 Furthermore, fragment size predicts future stone growth and complications: in patients with RF after ureteroscopy, Chew et al reported that fragments between 2–4 mm were associated with stone growth but not with complications or re-intervention, whilst fragments larger than 4mm were associated with both growth and complications. 64 The goal of managing the increasing burden of stone disease is therefore to choose the correct procedure for the correct stone in the appropriate patient to maximise the chance of a genuinely stone free patient (or at least with RF less than 2 mm in size) to provide the best event-free long-term result.…”