Introduction: Many patients self-report renal colic as the worst pain of their lives. Despite extensive evidence that stone recurrence can be reduced up to 60% with behavioral changes, as many as 75% of patients have difficulty following recommendations. Many are lost to follow up. We investigate if patients who present with symptomatic stone events have a higher rate of follow up than those who are asymptomatic.
Methods: Data was collected from the Registry for Stones of the Kidney and Ureter (ReSKU), a prospectively collected clinical database specific to kidney stone patients from October 2015-May 2019. We included only recurrent stone formers because routine follow up after first time stone formation is controversial. The primary exposure variable was whether or not patients were self identified as symptomatic at their first stone presentation as part of ReSKU. Follow up was defined as a return to clinic any time after 30 days post operatively or after initial clinic visit. Analyses were controlled for sex, age, race, body mass index, language, education and stone episodes requiring surgery. Multivariate logistic regression was used to estimate the association between symptoms at presentation and patient follow up.
Results: Four hundred and seventy two patients met study criteria. Most were symptomatic 442 (93%) and 237 (47.8%) and were managed non operatively. Overall, 181 (36.5%) of patients adhered to a follow up appointment either >30 days after surgery or initial clinic presentation. There were no differences in patient variables between symptomatic and asymptomatic patients. Our multivariate model showed that symptoms at time of initial presentation did not increase likelihood of adherence to follow up (adjusted OR: 0.81 (95% CI: 0.32-2.01). See Table 1. There appeared to be a dose effect on follow up for patients who had 1 (OR: 3.37 [95% CI 2.10-5.42]) or 2 (OR: 9.7 [95% CI 4.15-22.9]) surgeries since enrollment in ReSKU compared to no surgery.
Conclusions: We found no association between symptoms at presentation and adherence to long term follow up for known stone formers. Rather, patients were more likely to follow up if their stone event led to multiple surgeries. These results highlight that proactive measures must be taken to improve follow up and adherence for urinary stone prevention and management. Source of