Patient-reported outcomes (PROMs) in stone surgery:
Published Date: 22nd January 2020
Publication Authors: Tolofari S, Starmer B, Agarwal K
Introduction
Patient-reported outcome measures (PROMs) assess the quality of care delivered from a patient’s perspective. There is a paucity of evidence reporting PROMs in the treatment of urolithiasis. In this study, we aimed to assess the impact of urological stone procedures on patients’ morbidity.
Methods
Data were prospectively collected over 12 months using the Cambridge renal stone PROMs questionnaire. Patients undergoing flexible ureterorenoscopy (fURS) or a first session of extracorporeal shockwave lithotripsy (ESWL) for renal stones were asked to complete a preoperative questionnaire. This questionnaire was repeated at one, 6 and 12 weeks postoperatively.
Results
Across five NHS trusts, a total of 106 patients was collected over the 12-month period. Sixty patients underwent ESWL with 46 patients having fURS. The mean age was 51 years. Median stone size in the fURS cohort was 10.43 mm; 86% of fURS patients were stented. Complete stone clearance was 77%. Of the ESWL cohort, median stone size was 6.53 mm. Only 3% of patients had a ureteric stent in situ; 74% of patients required more than two sessions.There were no significant differences in preoperative PROMs scores for both treatment groups. At one week, the fURS PROMs were significantly higher than ESWL (P<0.01). However, at both 6 and 12 weeks ESWL had significantly higher PROMs scores (P<0.05).
Discussion
The fURS cohort had a significantly higher PROMs score at week one, suggesting a higher initial morbidity. However, PROMs scores at 6 and 12 weeks postoperatively were significantly higher with ESWL. This may be be due to factors including ureteric stent symptoms in the immediate postoperative period. Repeated sessions with ESWL perhaps explain the higher PROMs score at 6 and 12 weeks, which may lead to continued symptoms or anxiety associated with repeated treatment.
Tolofari, S; Starmer, B; Agarwal, K et al. (2020). Patient-reported outcomes (PROMs) in stone surgery: a multicentre study of patient experience of flexible ureteroscopy versus extracorporeal shockwave lithotripsy. Journal of Clinical Urology. 13 (1), 83