Category: Clinical Stones: Outcomes

MP8-19 - Is Stone-Free Status After Surgical Intervention for Kidney Stones Associated with Better Health-Related Quality of Life?- A Multicenter Study from the North American Stone Quality of Life Consortium

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective : Kidney stones cause impaired health-related quality of life (HRQOL), which has become an increasingly important outcome measurement. The aim of this study was to compare the HRQOL of patients with residual stone fragments after surgical intervention for kidney stones to patients that are stone-free using the disease-specific Wisconsin Stone Quality of Life (WISQOL) questionnaire.

Methods :

With IRB approval, 265 adult patients who underwent surgical intervention for kidney stones at 4 centers completed a WISQOL questionnaire. We retrospectively collected surgical data including presence of residual fragments on post-operative imaging. We calculated standardized WISQOL total and domain scores (0-100), including social functioning (D1), emotional functioning (D2), stone-related impact (D3) and vitality (D4). Scores were compared between patients with residual fragments to those who were stone-free on the laterality of the surgical intervention. 

Results : Demographics did not differ between groups, overall mean age 55.2 ± 14.1 and 50.6% female. There was no significant difference in standardized total WISQOL score for patients with residual stone fragments (n=128) compared to patients that were stone-free (n=137), 76.3 ± 23.0 vs 79.8 ± 20.2 respectively, (p=0.22). In addition, there was no significant difference for individual domain scores (D1:  83.9 vs 87.4, p= 0.25, D2: 72.2 vs 77.3, p= 0.12, D3: 72.8 vs 76.3, p= 0.30, D4: 71.8 vs 72.1, p= 0.94).  However, compared to stone-free patients those with residual stone fragments reported significantly more frustration with their situation (4.08 ± 1.16 vs 3.75 ± 1.41, p = 0.05).

Conclusions : Preliminary evidence suggests that stone-free status after surgical intervention is not associated with better HRQOL. These results suggest that in a properly counseled patient, surveillance of non-obstructing residual stone fragments may be an acceptable management strategy. Identifying that patients with residual fragments may have more frustration with their situation may help to improve patient counseling and properly set expectations.

Necole M. Streeper

Assistant Professor of Surgery
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania

Matthew Galida

Hershey, Pennsylvania

Eric Raffin

Lebanon, New Hampshire

Vernon Pais

Associate Professor, Associate Program Director
Lebanon, New Hampshire

Vernon Pais is an endourologist with clinical and research focuses on urolithiasis. He is an associate professor at the Geisel School of Medicine at Dartmouth and serves as the director of urologic research and associate program director for the urology residency at Dartmouth.

Shuang Li

Madison, Wisconsin

Ben H. Chew

Associate Professor, Department of Urologic Sciences
University of British Columbia
Vancouver, British Columbia, Canada

Dr. Chew is a urologist and the Director of Clinical Research at the Stone Centre at Vancouver General Hospital and an Associate Professor of Urology at the University of British Columbia in Vancouver, Canada. His main interests lie in the treatment and research of the pathophysiology of kidney stone disease. His research focus includes metabolic stone disease as well as biomaterials used in the urinary tract for ureteral stents. He has worked on various stent designs, stent coatings and drug-eluting ureteral stents to try and improve the quality of life for patients with kidney stone disease. He continues work on a degradable ureteral stent and has completed the first-in-human trials. Current studies include attempting to understand second messenger systems that are activated within the kidney and ureter once a ureteral stent has been placed. These could be exploited as future therapeutic targets for new drug eluting ureteral stents or designs to reduce symptoms.
He has authored over 80 peer-reviewed manuscripts and book chapters. He is a member of the Endourologic Disease Group for Excellence (EDGE) research consortium ( and the Wisconsin Quality of Life (WISQoL) research consortium. Dr. Ben Chew is also the Chair of Research for the Endourology Society. The role of the Research Chair is to facilitate and help improve research for the entire society.

Stephen Y. Nakada

University of Wisconsin School of Medicine and Public Health, Department of Urology
Madison, Wisconsin

Stephen Y. Nakada, MD, FACS is Professor and founding Chairman of the Department of Urology and the David T. Uehling Chair of Urology at the University of Wisconsin School of Medicine and Public Health in Madison, WI. He received his medical degree from the University of Rochester School of Medicine and Dentistry, and completed his residency training at Strong Memorial Hospital in Rochester, NY. Dr. Nakada went on to complete his Endourology Fellowship at Washington University prior to joining the faculty at the University of Wisconsin in 1995. Dr. Nakada has been the Chairman of Urology in Madison since 2001.

Dr. Nakada's research focuses on urolithiasis and renal aspects of minimally invasive urology. He has authored or co-authored over 200 scientific articles, 50 book chapters, and he has edited more than 10 textbooks in those areas. In 2004, Dr. Nakada received the Gold Cystoscope Award and in 2017 he received the Distinguished Service Award from the AUA. He is currently an editorial consultant for Urology Times and an Assistant Editor of the Journal of Endourology.

Dr. Nakada has served as President of the R.O.C.K. Society, Society of Academic Urologists and the Endourological Society. He has served on the AUA Staghorn Stone and Ureteral Stones Guidelines Committees, the AUA/ABU Examination Committee, and he served as the Chair of the AUA Laparoscopy & Robotic Surgery Committee. Currently, Dr. Nakada is President of the American Board of Urology and a member of the Advisory Council in Urology to the American College of Surgeons. Dr. Nakada is an active member of the American Association of Genitourinary Surgeons and the Clinical Society of Genitourinary Surgeons, among other societies.

Kristina L. Penniston

Senior Scientist
University of Wisconsin School of Medicine and Public Health, Department of Urology
Madison, Wisconsin

Kristina Penniston is a scientist and registered dietitian nutritionist in Madison, Wisconsin. Dr. Penniston earned her PhD in nutritional science from the University of Wisconsin-Madison. She completed a dietetic internship at the University of Wisconsin Hospital and Clinics and is a certified dietitian member and fellow of the Academy of Nutrition and Dietetics. Dr. Penniston has provided clinical nutrition services to patients with kidney stones and other urologic diseases, such as urologic cancer and benign urologic conditions, for 20 years. Dr. Penniston's research in the Department of Urology at the University of Wisconsin School of Medicine and Public Health focuses on prevention of kidney stones. Specifically, her research aims to develop and test dietary interventions that prevent or ameliorate recurrent stones; promote patients' self-efficacy in managing their stone disease; and understand and improve patients’ health-related quality of life. Dr. Penniston has developed a porcine model of dietary-induced calcium oxalate urolithiasis as a platform for studying dietary influences on stone formation. She also helped to develop the Wisconsin Stone Quality of Life questionnaire, a stone-specific instrument to assess patients' health-related quality of life. Dr. Penniston is a member of the American Urological Association and is a former research scholar (2008-2010). She has been a member of the Research on Calculus Kinetics (ROCK) Society since 2008 and was elected in 2018 as secretary/treasurer. Dr. Penniston publishes regularly in urologic and nutrition journals.