Non-obstructing Renal Stones and Their Effect on Stone-Related Quality of Life
Eric P. Raffin, MD1; David R. Brown, BS2; Vernon M. Pais, Jr., MD1
1Dartmouth Hitchcock Medical Center, Lebanon, NH; 2Geisel School of Medicine, Dartmouth College, Hanover, NH
BACKGROUND: Non-obstructing renal stones (NORS), while largely asymptomatic, have potential for causing future stone episodes. These may be either treatment naïve renal stones (TNS) or retained stone fragments (RSF) identified after surgical intervention. More frequent stone episodes and interventions have been associated with worse health related quality of life (HRQOL). HRQOL has become an increasingly important measure of treatment outcomes for the management of nephrolithiasis. We sought to evaluate if patients with the presence of known NORS experienced worse stone-related HRQOL.
METHODS: Utilizing the previously validated Wisconsin Stone-QOL questionnaire (WISQOL), a kidney stone-specific instrument, we analyzed retrospective data from patients new to and established at a tertiary care center metabolic stone clinic. We compared HRQOL in the domains of social, emotional, and disease impact, and vitality between patients with TNS, RSF, and those without either at the time of WISQOL study enrollment using student t-test. Additionally, multivariate regression was used to assess for significance when adjusting for age, BMI, and number of stone events.
RESULTS: 160 patients were included, of whom 82 had treatment naïve renal stones, 17 had retained stone fragments after intervention, 6 had both, and 55 had neither at time of study enrollment. There was no significant difference in total WISQOL scores for patients with TNS or RSF compared to patients with neither (105.3 vs. 107.5, p=0.61). There was no significant differences in individual domain scores between the groups as well (all p≥0.50). When patients with TNS were compared to those with RSF, there was no significant difference in total WISQOL scores (104.5 vs 105.5, p=0.88). There was no significant differences in individual domain scores between patients with TNS and those with RSF (all p≥0.36). HRQOL remained similar on multivariate analysis.
CONCLUSIONS: Patients with TNS and RSF experience no significant difference in HRQOL compared to each other. Individuals with NORS also may not experience any worse HRQOL compared to those with history of nephrolithiasis who are stone free. These findings can be useful in counseling patients with known NORS and confirm that watchful waiting can be employed in this population without impairment in current stone-specific HRQOL.
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