Category: Clinical Stones: Outcomes
Introduction & Objective :
The Wisconsin Stone Quality of Life questionnaire (WISQoL) is an externally validated health-related quality of life (HRQoL) instrument for patients with stone disease. We sought to validate WISQoL as a measure of HRQoL in the perioperative setting of ureteroscopy for renal and ureteral calculi.
We prospectively assessed quality of life using WISQoL in consecutive patients with renal and/or ureteral calculi undergoing ureteroscopy and stone treatment between October 2017 and March 2018. All patients had stents placed post-operatively. The only modification to the previously validated WISQoL instrument was to inquire about the effects of kidney stones “over the past week” rather than “during the past month” to provide short-term assessment of QoL in the URS peri-operative period. Prior to surgery patients completed the modified WISQoL, a visual analog pain scale (VAS) and validated instruments to assess depression (patient health questionnaire 9 - PHQ-9) and anxiety (State-Trait Anxiety Inventory - STAI). WISQoL and VAS were also administered immediately before office stent removal. Sensitivity to change between time points was assessed using the student’s paired t-test. Internal consistency was evaluated using Cronbach’s alpha. Convergent validity was tested by correlating specific WISQoL domains to STAI, PHQ-9, and VAS as appropriate using spearman’s test. Statistical significance was considered at p≤0.01.
A total of 51 patients completed WISQoL at both time time-points. A significant reduction in D1-social (-19.7%, p<0.001), D3-disease (-15.4%, p =0.002), and total WISQOL (-13.1%, p=0.002) scores were detected from baseline to the time of stent removal. Patients with the highest (best) pre-operative HRQoL were more likely to demonstrate a decline in HRQoL at the time of stent removal compared to patents with lower preoperative HRQoL scores. Cronbach’s alpha coefficient was >0.7 for total WISQOL and each domain score at both time-points. The preoperative WISQoL showed convergent validity with all corresponding validated questionnaires. WISQoL at stent removal showed convergent validity only with VAS pain scale (r=-0.515, p <0.001) and trait anxiety (r=-0.406, p=0.003), but not state anxiety or depression.
Conclusions : Modification of WiSQoL to assess effects of stones “over the past week” in the perioperative setting of ureteroscopy with stent placement performs as a reliable and internally consistent instrument, validating its use in the short-term setting of ureteroscopy.
Brett Johnson– Endourology Fellow, UT Southwestern, Dallas, Texas
Igor Sorokin– Dallas, Texas
Kristina Penniston– Senior Scientist, University of Wisconsin School of Medicine and Public Health, Department of Urology, Madison, Wisconsin
Margaret Pearle– Dallas, Texas
Jodi Antonelli– Assistant professor urology, UT Southwestern, Dallas, Texas
Brett Johnson, is the current second-year Endourology fellow at University of Texas Southwestern with Drs. Jeffrey Cadeddu and Margret Pearle. He completed residecny in Urology at the University of Wisconson.
University of Wisconsin School of Medicine and Public Health, Department of Urology
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.
Assistant professor urology
Jodi Antonelli, M.D. is an Assistant Professor in the Department of Urology at UT Southwestern Medical Center. She specializes in the medical and surgical management of kidney stone disease.
Dr. Antonelli earned her medical degree from Jefferson Medical College of Thomas Jefferson University. She completed a general surgery internship and a urology residency at Duke University Medical Center. She completed a fellowship in endourology and stone disease in the Department of Urology at UT Southwestern.
Her research interests include evaluation of dietary and medical therapies for kidney stone prevention, assessment of outcomes for minimally invasive surgical treatments, and development and assessment of surgical innovation. She was the recipient of the 2014 Elisabeth Pickett Research Award for the Society of Women in Urology.
Dr. Antonelli is a member of the American Urological Association, the Endourological Society, and ROCK Society.