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

Published:December 05, 2020DOI:


      To compare the health-related quality of life (HRQOL) of patients with residual fragments after surgical intervention for kidney stones to patients that are stone-free using the disease-specific Wisconsin stone quality of life (WISQOL) questionnaire. Kidney stones contribute to impaired HRQOL, which is increasingly recognized as an important healthcare outcome measurement.


      With institutional review board approval, 313 adult patients who underwent surgical intervention for kidney stones at 4 sites 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), which included items related to 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 after surgical intervention.


      Demographics did not differ between groups, overall mean age 54.6 ± 13.5 and 55.4% female. There was no significant difference in total WISQOL score for patients with residual fragments (n = 124) compared to patients that were stone-free (n = 189), 110.5 ± 27.8 vs 115.4 ± 23.6 respectively, (P = .12). Interestingly, patients with residual fragments who underwent secondary surgery were found to have significantly lower total WISQOL score (88.4 ± 30.1 vs 116.6 ± 25.0, P <.0001).


      Stone-free status after surgical intervention is not associated with better HRQOL when compared with patients whose surgeries left residual fragments. Indeed, further surgical intervention on residual fragments to achieve stone-free status may actually result in worse HRQOL.
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        • Scales CD
        • Smith AC
        • Hanley JM
        • et al.
        Urologic diseases in America Project. Prevalence of kidney stones in the United States.
        Eur Urol. 2012; 62: 160-165
        • Pearle MS
        • Calhoun EA
        • Curhan GC
        Urologic diseases in America project: urolithiasis.
        J Urol. 2005; 173: 848-857
        • Sutherland JW
        • Parks JH
        • Coe FL
        Recurrence after a single renal stone in a community practice.
        Miner Electrolyte Metab. 1985; 11: 267-269
        • Penniston KL
        • Nakada SY
        Treatment expectations and health-related quality of life in stone formers.
        Curr Opin Urol. 2016; 26: 50-55
        • Penniston KL
        • Sninsky BC
        • Nakada SY
        Preliminary evidence of decreased disease-specific health-related quality of life in asymptomatic stone patients.
        J Endourol. 2016; 30: S42-S45
        • Donnally CJ
        • Gupta A
        • Bensalah K
        • et al.
        Longitudinal evaluation of the SF-36 quality of life questionnaire in patients with kidney stones.
        Urol Res. 2011; 39: 141-146
        • Bryant M
        • Angell J
        • Tu H
        • et al.
        Health related quality of life for stone formers.
        J Urol. 2012; 188: 436-440
        • Vanstone M
        • Rewegan A
        • Brundisini F
        • et al.
        Patient perspectives on quality of life with uncontrolled type 1 diabetes mellitus: a systematic review and qualitative meta-synthesis.
        Ont Health Techol Assess Ser. 2015; 15: 1-29
        • Martinez-Sanchis S
        • Bernal MC
        • Montagud JV
        • et al.
        Quality of life and stressors in patients with chronic kidney disease depending on treatment.
        Span J Psychol. 2015; 18: E25
        • Diniz DH
        • Blay SL
        • Schor N
        Quality of life of patients with nephrolithiasis and recurrent painful renal colic.
        Nephron Clin Pract. 2007; 106: 91-97
        • Bensalah K
        • Tuncel A
        • Gupta A
        • et al.
        Determinants of quality of life for patients with kidney stones.
        J Urol. 2008; 179: 2238-2243
        • Modersitzki F
        • Pizzi L
        • Grasso M
        • et al.
        Health-related quality of life (HRQoL) in cystine compared with non-cystine stone formers.
        Urolithiasis. 2014; 42: 53-60
        • Patel N
        • Brown RD
        • Sarkissian C
        • et al.
        Quality of life and urolithiasis: the patient-reported outcomes measurement information system (PROMIS).
        Int Braz J Urol. 2017; 43: 880-886
        • Streeper NM
        • Wertheim ML
        • Nakada SY
        • et al.
        Cystine stone formers have impaired health-related quality of life compared with noncystine stone formers: a case-referent study piloting the Wisconsin stone quality of life questionnaire among patients with cystine stones.
        J Endourol. 2017; 31: S48-S53
        • Penniston KL
        • Nakada SY
        Health related quality of life differs between male and female stone formers.
        J Urol. 2007; 178: 2435-2440
        • Sahin C
        • Tuncer M
        • Yazici O
        • et al.
        Do the residual fragments after shock wave lithotripsy affect the quality of life?.
        Urology. 2014; 84: 549-554
        • Sahin C
        • Kafkasli A
        • Centinel CA
        • et al.
        How do the residual fragments after SWL affect the health-realted quality of life? A critical analysis in a size-based manner.
        Urolithiasis. 2015; 43: 163-170
        • Ghani KR
        • Wolf Jr, JS
        What is the stone-free rate following flexible ureteroscopy for kidney stones?.
        Nat Rev Urol. 2015; 12: 281-288
        • Raja A
        • Hekmati Z
        • Joshi HB
        How do urinary calculi influence health-related quality of life and patient treatment preference: a systematic review.
        J Endourol. 2016; 30: 727-743
        • Penniston KL
        • Nakada SY
        Development of an instrument to assess the health related quality of life of kidney stone formers.
        J Urol. 2013; 189: 921-930
        • Penniston KL
        • Antonelli JA
        • Viprakasit DP
        • et al.
        Validation and reliability of the Wisconsin stone quality of life questionnaire.
        J Urol. 2017; 197: 1280-1288
        • Rippel CA
        • Nikkel L
        • Lin YK
        • et al.
        Residual fragments following ureteroscopic lithotripsy; incidence and predictors on postoperative computerized tomography.
        J Urol. 2012; 188: 2246-2251
        • Rabah DM
        • Alomar M
        • Binsaleh S
        • et al.
        Health related quality of life in ureteral stone patients: post-ureterolithiasis.
        Urol Res. 2011; 39: 385-388
        • Dropkin BM
        • Moses RA
        • Sharma D
        • et al.
        The natural history of nonobstructing asymptomatic renal stones managed with active surveillance.
        J Urol. 2015; 193: 1265-1269
        • Kartha G
        • Calle JC
        • Marchini GS
        Impact of stone disease: chronic kidney disease and quality of life.
        Urol Clin N Am. 2013; 40: 135-147