(UroToday.com) The 2024 World Congress of Endourology and Uro-Technology Conference continued its Thursday morning plenary session with a discussion on important stone disease outcomes, moderated by the esteemed Dr. Hassan Razvi. The session brought together key experts in stone disease to explore outcomes including quality of life, cost, stone-free rates, and complications associated with kidney stone treatment.
Dr. Razvi opened the session by defining the importance of outcomes research, outlining its core goals: assessing the quality of care, access to health services, and the effectiveness of treatment strategies. His emphasis was on how these findings are vital in shaping health policy and clinical decision-making, especially in complex fields like stone disease treatment.
Dr. Margaret Knoedler captivated the audience with her focus on quality of life. Citing Paul Lembcke, she reinforced that the true measure of healthcare quality is in its ability to prolong life, alleviate suffering, and restore function. Dr. Knoedler introduced the Wisconsin Stone Quality of Life Score, a valuable tool for evaluating the well-being of patients affected by kidney stones. Her data revealed that patients with a history of recurrent stones, multiple procedures, or significant comorbidities report significantly lower quality of life.
In a study involving 313 patients, Dr. Knoedler shared findings that demonstrated no significant difference in quality of life based on residual stones after surgery, though those requiring additional procedures experienced a decline in health-related quality of life (HRQOL) which was significantly more impactful to the patient. Her conclusion: HRQOL must be at the forefront of treatment planning to better serve patients’ long-term needs.
The Financial Burden of Stone DiseaseDr. Ryan S. Hsi followed with a detailed exploration of the economic impact of kidney stone disease. He revealed staggering statistics, with over $10 billion spent annually in the U.S. on treatment and follow-up care for stone disease. The financial toll on patients was equally daunting: as many as 1 in 4 patients experience substantial financial strain due to their condition.
Dr. Hsi emphasized the role of surgeons in mitigating these costs. Choices around equipment, surgical techniques, and resource management can dramatically alter the financial burden of procedures. He also highlighted the environmental costs, pointing out that operating rooms are responsible for 70% of hospital waste and urging surgeons to adopt more sustainable practices.
Stone-Free Rates: A Critical MeasureDr. Karen Stern discussed the critical role of stone-free rates (SFR) in evaluating the success of different surgical interventions. For years, SFR has been the gold standard in urology, and Dr. Stern detailed why it still matters.
Using data from treatments like shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy, Dr. Stern demonstrated that residual fragments often lead to complications or the need for reintervention. In one study, 44% of patients with residual stones after ureteroscopy had a stone-related event within 12 months. These findings supported her assertion that stone-free status remains critical to patient outcomes, urging the adoption of volumetric stone-free rates as a more accurate and meaningful measure for future studies.
Complications and Their ManagementDr. Young Eun Yoon closed the session by addressing the complications that can arise during and after stone surgery, such as infections, organ injury, and stone recurrence. His discussion zeroed in on post-operative infections, which pose a serious risk, especially in patients with risk factors like diabetes or larger stone burdens.
Dr. Yoon emphasized the importance of minimizing intrapelvic pressure during procedures and highlighted innovations like the LithoVue Elite scope to help manage these risks. He concluded by stressing the need for vigilance in monitoring patient health, both during surgery and in the post-operative phase, to reduce complication rates and improve outcomes.
ConclusionThe session reinforced that while technological advancements continue to transform urologic care, challenges remain. The panelists collectively stressed the importance of considering not just clinical outcomes but also the economic, environmental, and quality-of-life factors that impact patients.
Presented by:
Moderator: Hassan Razvi, MD. Profession, Division of Urology, Department of Surgery, Western University, London, Ontario
Panelists:
- Quality of Life – Margaret Knoedler, MD. Assistant Professor, Mayo Clinic Rochester, Rochester, MN
- Cost – Ryan S. Hsi, MD. Assistant Professor, Vanderbilt University Medical Center, Nashville, TN
- Stone Free Rate – Karen L. Stern, MD. Associate Professor, Mayo Clinic Arizona, Scottsdale, AZ
- Complication – Young Eun Yoon, MD. Professor, Hanyang University, Seoul, South Korea