Technology to treat kidney stones has improved so much and open stone surgery which has all but vanished. With the advent of shockwave lithotripsies, laser lithotripsy, percutaneous nephrolithotomy, and smaller digital ureteroscopes, we are upon the most advanced technological aspect in kidney stone treatment. Which methods offer the best quality of life?
The 3 main surgical techniques at our disposal for kidney treatment include shockwave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy. Until recently, almost the entire focus has been on "which modality offers the best stone free rate". Furthermore, with CT being so commonly used, our ability to detect small residual fragments is now magnified.
Which of the 3 modalities offers the best quality of life (irrespective of stone free rates)?
Does stone free rate affect the QOL? Or do multiple surgeries matter more?
Is the QOL equal or better with one modality despite differences in stone free rates? Preliminary evidence supports improved QOL in patients undergoing SWL vs ureteroscopy (despite having a lower stone free rate in the SWL group).
Has CT scan and the "over-detection" of residual fragments result in multiple surgeries in our quest for "truly stone free" affected patient's QOL? Are we over-treating small fragments and performing multiple surgeries at the expense of our patients' QOL?
The Wisconsin Quality of Life (WISQOL) health related quality of life outcome questionnaire is a validated tool specific to patients with urinary stones. This is a prospective study that will follow patients after various surgeries and track their QOL. This will be compared among surgeries and also those who undergo multiple surgeries.
Kristin Penniston, PhD and Stephen Nakada, MD were the two original developers of the WISQOL and will team up with TOWER researchers in order to answer this important question for our patients.