The Duration of Stone Disease and the Impact of a Stone Event on Patients' Quality of Life

Abstract

Introduction:

With a 5-year stone recurrence rate of 30% to 50%, kidney stone formers are subject to significant morbidity that negatively impacts their health-related quality of life (HRQOL). We sought to determine the impact of age at kidney stone onset, duration of stone disease, and kidney stone event (surgery or stone passage) on HRQOL of individual patients by querying the validated and prospectively collected Wisconsin Stone Quality of Life (WISQOL) database.

Patients and Methods:

Cross-sectional data were obtained from a total of 2438 kidney stone formers from 14 institutions in North America who completed the WISQOL questionnaire during the period from 2014 to 2019. The 28-question survey has a 1- to 5-point scale for each item (total score range 0–140). Multivariable linear regression models assessed the impact of age at kidney stone onset, duration of stone disease, and time since most recent surgery or stone passage on HRQOL.

Results:

Of 2438 patients, older age at kidney stone onset and longer duration of disease were both independent predictors of better WISQOL scores (β = 0.33 points/year; confidence interval [CI] 0.17–0.49; p < 0.001; and β = 0.50 points/year; CI 0.32–0.68; p < 0.001, respectively). Of 1376 patients who underwent surgery between 2010 and 2019, longer time since most recent surgery was an independent predictor of better WISQOL scores (β = 2.28 points/year; CI: 1.47–3.10; p = <0.001). Of 1027 patients with spontaneous stone passage occurring between 2010 and 2019, longer time since most recent stone passage was an independent predictor of better WISQOL scores (β = 1.59 points/year; CI: 0.59–2.59; p = <0.05).

Conclusions:

Our study demonstrates that older age at onset, longer duration of disease, and longer time since most recent surgery or stone passage were independent predictors of better HRQOL in kidney stone formers. Results of future studies that focus on optimizing stone-related modifiable risk factors to decrease the number of recurrent stone episodes and thus the need for recurrent surgeries will be essential.

Introduction

Kidney stone prevalence has been rising over the past few decades with an estimated prevalence of 10.1% in the United States in 2016, contributing to numerous costs of treatment and lost worker productivity.^1,2 Numerous explanations contribute to understanding this rise in prevalence, such as increasing obesity, poor diet, and poor control of diabetes.³

Additionally, previous studies using the Short Form General Health Survey (SF-36), a generic measure of health status and health-related quality of life (HRQOL), demonstrated that kidney stone formers had a lower perceived HRQOL when compared with healthy individuals. However, this tool failed to differentiate stone-related symptoms.⁴ Recently, the Wisconsin Stone Quality of Life (WISQOL) disease-specific questionnaire was developed and validated for use in kidney stone formers, which led to identification of numerous demographic factors impacting disease-specific HRQOL in kidney stone formers, such as ethnicity and socioeconomic factors.^5,6

It is of importance to note that kidney stone formers have a better perceived HRQOL when treatment regimen outcomes meet their expectations.⁷ Therefore, good HRQOL is an important outcome in management of urolithiasis in kidney stone formers. Previous studies have demonstrated a correlation between increased stress and frequent kidney stone passage in kidney stone formers.⁸

We aimed to assess the impact of age at kidney stone onset and duration of stone disease on WISQOL scores in kidney stone formers. In addition, we hypothesized that HRQOL of kidney stone formers would improve as more time elapsed after their most recent kidney stone event (surgery or kidney stone passage).

Patients and Methods

Our study consists of a cross-sectional analysis of data from a large, multi-institutional prospectively collected database. Patients were recruited at 16 tertiary care outpatient centers situated in the United States and Canada between June 2014 and May 2019. The institutional review board approved the study at each site. Patients were eligible for enrollment if they were English or French speaking, had a history of kidney stones, and were over the age of 18.

All patient data were obtained at enrollment. The previously validated WISQOL questionnaire was completed by each patient. A validated French-language version was available for patients recruited at two sites.⁹ The 28-question survey has a 1- to 5-point scale for each question (total score range 28–140), with higher scores indicating better quality of life than lower scores.

The questionnaire is divided into four domains: D1 social functioning, D2 emotional functioning, D3 stone-related impact, and D4 vitality. In addition to kidney stone-specific HRQOL, data on individual patient comorbidities, number of previous stone events, age at onset of kidney stone disease, duration of disease at the moment of enrollment, and year of most recent surgical intervention and most recent stone passage were obtained directly from each participant.

Surgical intervention was defined as retrograde ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or extracorporeal shockwave lithotripsy (SWL). Demographic information, including age, gender, ethnicity, and body mass index (BMI), was also obtained directly from each participant. Use of medical therapy was recorded, such as thiazide and potassium citrate use.

All patient data were anonymized and deidentified before analysis. Kidney stone formers were given a list of 23 occupations from the U.S. Bureau of Labor Statistics (BLS), with the additional options of unemployed/retired and homemaker/caregiver.¹⁰ For study purposes, the 23 occupations were categorized into four groups according to BLS guidelines.¹¹

Additionally, kidney stone formers who selected unemployed/retired were categorized as unemployed if they were younger than 62 years of age or retired if they were 62 years of age or older, according to the age at which Social Security benefits first become available. BMI was defined according to categories defined by the CDC (Centers for Disease Control and Prevention). An additional threshold with a BMI >40 kg/m² was defined as superobese.¹²

Stone events were categorized as single (0–1), recurrent (2–5), and severe recurrent (≥6), according to a previous report.¹³ Duration of disease was defined as the number of years since onset of kidney stone disease for each individual kidney stone former. Recent stone events were defined as either spontaneous stone passage or surgery occurring before filling the WISQOL questionnaire.

Statistical analyses

Univariable and multivariable linear regression analyses were performed to evaluate the impact of each kidney stone clinical variable on HRQOL. More specifically, age at kidney stone onset, duration of disease, and the impact of time since the last stone event (surgery or stone passage) were assessed according to previously reported clinical variables impacting the HRQOL of kidney stone formers, such as ethnicity, gender, BMI, number of events, and occupation, as well as recurrent urinary tract infections, lower urinary tract symptoms (LUTS), and signs and symptoms of depression/anxiety.⁶

Separate linear regression models were used to assess the impact of age at onset and duration of disease, as well as the impact of time since the last stone event (surgery or stone passage). Linearity of the relationship among our variables was assessed. Normal distribution of our variables of interest was assumed according to previous literature utilizing the WISQOL database.^6,13
–15

The absence of multicollinearity was ensured with the use of a variance inflation factor (VIF), with a cutoff of VIF <10. The absence of heteroscedasticity was confirmed with the use of the Goldfeld–Quandt test. Statistical significance was considered at α = 0.05.

All statistical analyses were performed in the R software environment for statistical computing and graphics (version 4.1.0 for PC; www.r-project.org).¹⁶

Results

Baseline characteristics

Baseline demographics are summarized in Table 1. A total of 2438 kidney stone formers were part of the study group. Median age at enrollment was 55 (interquartile range [IQR]: 43–65) years. Median WISQOL score was 117 (IQR: 89–132) points. Median age at kidney stone disease onset was 40 (IQR: 28–54) years, and median duration of stone disease was 8 (IQR: 1–20) years. Management position was found to be the most frequent occupation in 1055 (43.3%) kidney stone formers.

Table 1.

Baseline Demographics and Clinical Variables of Kidney Stone Formers from the Wisconsin Stone Quality of Life Database, from 2014 to 2019^a

	Overall (n = 2438)
Age (year), median (IQR)	55(43–65)
Gender, n (%)
Male	1265 (51.9)
Female	1173 (48.1)
Age at onset (year), median (IQR)	40 (28–54)
Duration of disease (year), median (IQR)	8 (1–20)
WISQOL score (points), median (IQR)	117 (89–132)
Occupation, n (%)
Homemaker/stay-at-home caregiver	163 (6.7)
Management	1055 (43.3)
Manual labor	162 (6.6)
Sales	356 (14.6)
Unemployed	196 (8.0%)
Retired	506 (20.8%)
BMI, n (%)
Underweight	22 (0.9%)
Normal	591 (24.2)
Overweight	786 (32.2)
Obese	774 (31.7)
Superobese	228 (9.4)
No. of events, n (%)
Single (0–1)	841 (34.5%)
Recurrent (2–5)	1003 (41.1%)
Severe recurrent (≥6)	594 (24.4%)

Nonstandardized WISQOL score was used (min–max is 28–140).

BMI = body mass index; IQR = interquartile range; WISQOL = Wisconsin Stone Quality of Life.

Kidney stone formers were then stratified according to recent year of surgery and recent year of spontaneous stone passage. A total of 1376 kidney stone formers had undergone a recent surgery during the period from 2010 to 2019, and 1027 kidney stone formers had a recent stone passage event during the period from 2010 to 2019. Median time, in years, since the most recent surgery or stone passage was 1 (IQR: 0–2) year.

Univariable and multivariable analysis of WISQOL scores

According to a univariable linear regression, age at onset, duration of disease, and time since most recent surgery or stone passage were independent predictors of better WISQOL scores (Supplementary Table S1). After adjusting for demographic and clinical variables, including the number of previous stone events, a multivariable linear regression was performed (Table 2).

Table 2.

Multivariable Linear Regression of Clinical Variable Effects on Health-Related Quality of Life of Kidney Stone Formers^a

		Multivariable
	β	CI	p
Age at onset (points/year)	0.33	(0.23–0.43)	<0.001
Duration of disease (points/year)	0.42	(0.30–0.54)	<0.001
Time since recent surgery (points/year)	2.18	(1.36–3.00)	<0.001
Time since recent spontaneous stone passage (points/year)	1.52	(0.52–2.52)	<0.05
Time since event (surgery or stone passage) (points/year)	3.66	(1.86–5.46)	<0.001

Adjusted according to ethnicity, BMI, bothersome urination (LUTS) or overactive bladder (OAB), urinary tract infections (more than one within the last 12 months), renal tubular acidosis, depression and anxiety symptoms, occupation category, inflammatory bowel disease or irritable bowel syndrome (Crohn's disease, celiac disease, chronic diarrhea, or idiopathic inflammatory bowel disease), short bowel or gastric bypass, diabetes mellitus type 2, gender, number of previous kidney stone events, medullary sponge kidney, osteopenia/osteoporosis, and thiazide and potassium citrate use.

Nonstandardized WISQOL score was used (min–max is 28–140).

CI = confidence interval; LUTS = lower urinary tract symptoms.

Age at onset was an independent predictor of better WISQOL scores. Kidney stone formers who were older when their first stone event occurred were more likely to have better WISQOL scores compared with participants who were younger at disease onset (β = 0.33 points/year; confidence interval [CI] 0.23–0.43; p < 0.001). Interestingly, longer duration of stone disease resulted in better WISQOL scores (β = 0.42 points/year; CI 0.30–0.54; p < 0.001).

Additionally, time since the most recent stone event was an independent predictor of better WISQOL scores. With increasing time from the most recent stone event, kidney stone formers who had undergone recent stone surgery had a ꞵ = 2.18 points/year (CI 1.36–3.00; p < 0.001) and recent stone passage patients had a ꞵ = 1.52 points/year (CI 0.52–2.52; p < 0.05) in WISQOL scores. Further subgroup analysis demonstrated that kidney stone formers who had undergone either recent stone surgery or stone passage had a β = 3.66 points/year (CI 1.86–5.46; p < 0.001).

Thus, in any given patient, over a 5-year follow-up period since their most recent stone event, it can be estimated that their score would have increased by an average of almost 20 points (of a 140-point scale).

Domain-specific WISQOL scores

A multivariable linear regression model was performed for each WISQOL subdomain (Table 3). Older age at onset and longer duration of disease were both independent predictors of better WISQOL scores for each subdomain: D1 social functioning, D2 emotional functioning, D3 stone-related impact, and D4 vitality (all p < 0.001).

Table 3.

Domain-Specific Multivariable Linear Regression of Clinical Variable Effects on Health-Related Quality of Life of Kidney Stone Formers^a

		Multivariable
	β	CI	p
Age at onset (points/year)	—	—	—
Social functioning (D1)	0.24	0.14–0.34	<0.001
Emotional functioning (D2)	0.42	0.31–0.52	<0.001
Stone-related impact (D3)	0.25	0.15–0.35	<0.001
Vitality (D4)	0.24	0.12–0.36	<0.001
Duration of disease (points/year)	—	—	—
Social functioning (D1)	0.37	0.25–0.49	<0.001
Emotional functioning (D2)	0.52	0.40–0.65	<0.001
Stone-related impact (D3)	0.31	0.19–0.43	<0.001
Vitality (D4)	0.29	0.15–0.42	<0.001
Time since recent surgery (points/year)	—	—	—
Social functioning (D1)	2.04	1.22–2.86	<0.001
Emotional functioning (D2)	2.54	1.67–3.41	<0.001
Stone-related impact (D3)	1.72	0.90–2.54	<0.001
Vitality (D4)	1.58	0.62–2.53	<0.001
Time since recent spontaneous stone passage (points/year)	—	—	—
Social functioning (D1)	1.47	0.45–2.50	<0.05
Emotional functioning (D2)	1.99	0.93–3.10	<0.001
Stone-related impact (D3)	1.08	0.09–2.06	<0.05
Vitality (D4)	1.31	0.17–2.45	<0.05

Adjusted according to ethnicity, BMI, bothersome urination (LUTS) or overactive bladder (OAB), urinary tract infections (more than one within the last 12 months), renal tubular acidosis, depression and anxiety symptoms, occupation category, inflammatory bowel disease or irritable bowel syndrome (Crohn's disease, celiac disease, chronic diarrhea, or idiopathic inflammatory bowel disease), short bowel or gastric bypass, diabetes mellitus type 2, gender, number of previous kidney stone events, medullary sponge kidney and osteopenia/osteoporosis, gastroesophageal reflux disease (reflux or heartburn), high cholesterol (hyperlipidemia), and thiazide and potassium citrate use.

Nonstandardized WISQOL score was used (min–max is 28–140).

Age at onset had the strongest effect on D2 emotional functioning (β = 0.42 [CI: 0.31–0.52] points/year, p < 0.001) and the weakest effect on D1 social functioning (β = 0.24 [CI: 0.14–0.34] points/year, p < 0.001) and D4 vitality (β = 0.24 [CI: 0.12–0.36] points/year, p < 0.001). Duration of disease had the strongest effect on D2 emotional functioning (β = 0.52 [CI: 0.40–0.65] points/year, p < 0.001) and the weakest effect on D4 vitality (β = 0.29 [CI: 0.15–0.42] points/year, p < 0.001).

Time since most recent surgery was also an independent predictor of better WISQOL scores for each subdomain (all p < 0.001). Time since most recent surgery had the strongest effect on D2 emotional functioning (β = 2.54 [CI: 1.67–3.41] points/year, p < 0.001) and the weakest effect on D4 vitality (β = 1.58 [CI: 0.62–2.53] points/year, p < 0.001).

Finally, time since most recent stone passage was an independent predictor of better WISQOL scores for each subdomain as well (all p < 0.05). Time since most recent stone passage had the strongest effect on D2 emotional functioning (β = 1.99 [CI: 0.93–3.10] points/year, p < 0.001) and the weakest effect on D3 stone-related impact (β = 1.08 [CI: 0.09–2.06] points/year, p < 0.05).

Discussion

The presence of urolithiasis has been independently associated with reduced HRQOL in kidney stone formers.^17,18 Repeated episodes of extreme pain during stone passage, subsequent fear of experiencing future episodes, and stress related to surgical treatments are all possible contributors of poor HRQOL in stone formers. Although recent stone passage can cause significant distress and acutely reduce patient quality of life, there may be gradual improvement in quality of life, beginning as soon as one month after a stone episode.¹⁸

We assessed both modifiable and nonmodifiable factors that influence HRQOL in 2438 kidney stone formers, using the WISQOL questionnaire and database. Notably, older age at stone disease onset, longer duration of stone disease, and longer time since the most recent stone event (surgery or stone passage) were all independent predictors of a higher WISQOL score.

Our findings establish that older age at kidney stone onset is an independent predictor of better WISQOL scores in kidney stone formers. Each increase in year of age at kidney stone onset led to a mild increase in the WISQOL score (0.33 points/year; p < 0.001). While the effect of age at onset on HRQOL is not entirely understood, the presence of stone-related comorbidities may negatively influence HRQOL in younger patients compared with spontaneous occurrence in older patients.

Stern et al. reported that the presence of urolithiasis may have less of an impact on older patients, who may be more concerned with other nonstone-related comorbidities.¹⁴ We further stratified our study group according to an age cutoff of 50 years.

We found that patients older than 50 years had a higher proportion of comorbidities, compared with patients younger than 50 years, such as hypertension, cardiovascular disease, diabetes, gout, LUTS, gastroesophageal reflux disease, osteoporosis, degenerative joint disease, musculoskeletal disorders, pancreatitis, hypothyroidism, and symptoms of depression/anxiety. These findings further corroborate the hypothesis that kidney stone events could have a lesser impact in older patients.

However, the present study does not corroborate the findings of Bensalah and colleagues, who demonstrated that younger age at onset was inversely associated with improved quality of life.¹⁹ One key difference between this study and that conducted by Bensalah et al. is that they did not use the WISQOL questionnaire, which is specific for kidney stone patients. Further studies evaluating the HRQOL of kidney stone formers should prioritize the use of the WISQOL questionnaire as it is a validated stone-specific assessment tool.

With no definitive cure, kidney stone disease is considered a chronic disease, characterized by sporadic acute stone events. Due to the nonlinear progression of the disease, it is difficult to predict how patients will experience their illness and its impact on their quality of life. The present study showed that the longer the duration of kidney stone disease, the more likely that the patients would experience higher HRQOL, even when adjusting for the number of stone events. This reflects the long-term changes in the quality of life of patients with urolithiasis.

In a study describing HRQOL in young patients with chronic conditions, longer disease duration was also associated with better HRQOL than shorter duration, possibly because patients have time to adapt to and cope with their illness.²⁰ Our study emphasizes this hypothesis because while younger age at onset is initially associated with worse HRQOL, clinicians can help modify patient-specific risk factors to aid in adapting to their chronic illness, which would lead to longer duration of disease and thus better HRQOL.

It should be noted that despite a long-term trend of relatively improved quality of life, it is likely that moments of markedly reduced quality of life would be interspersed over the patient's lifetime as an immediate consequence of acute stone events. Nonetheless, these findings demonstrate an overall improvement in quality of life compared with shorter stone disease duration.

In our study, each increase in year for the duration of the disease led to a mild WISQOL score increase of 0.50 points/year (p < 0.001).

By documenting changes in HRQOL after the most recent stone event, we could assess the impact of acute events. We observed that each additional year since a kidney stone passage or kidney stone surgery led to improved WISQOL scores in our multivariable analysis. More specifically, each additional year without a stone event (stone surgery or stone passage) led to an increase of 3.66 points (CI: 1.86–5.46; p < 0.001) on the WISQOL questionnaire.

Our findings are comparable with a study by Bryant and colleagues who reported similar results in which kidney stone formers reported lower HRQOL with bodily pain and physical pain when stone events occurred less than one month before SF-36 completion.²¹ However, Donnally et al. reported no difference in HRQOL for kidney stone formers with a recent stone event after a median interval of 18 months between initial and follow-up SF-36 completion.²²

Both studies are limited by the fact that the SF-36 questionnaire may have inadequate sensitivity to evaluate the quality of life over time in stone patients because it was not specifically developed for kidney stone formers, unlike the WISQOL questionnaire. Therefore, we strongly believe that our results provide a better estimation of the impact of a recent stone event on patient HRQOL.

Our findings demonstrated that older age at onset, longer duration of disease, and longer time since the most recent event (surgery or stone passage) had the strongest effect on D2 emotional functioning in kidney stone formers. D2 addresses anxiety or worry and reduced ability to cope with everyday responsibilities and issues, as well as patient irritability.

Our findings are in contrast with those of Bensalah and colleagues who reported that patient HRQOL with a recent stone episode (before or after 1 month) did not differ from that of healthy American individuals in regard to emotional functioning according to the SF-36.¹⁹ Again, differences in our data can be explained by the fact that the SF-36 is not a disease-specific questionnaire.

The cross-sectional design would be the main limitation of this study, which does not allow for causal inference. Its cross-sectional nature also limits the appreciation of HRQOL dynamism over time to a linear relationship, which may ignore variations in the improvement rate over time. An additional limitation of this study is that our outcomes of interest were obtained from a patient population being treated and followed at highly specialized tertiary care centers.

Many study patients had a significant number of stone-related comorbidities and a higher frequency of stone-related events. Therefore, our study outcomes could be less applicable to the everyday kidney stone former who does not require treatment at a highly specialized center.

In addition, in our study group, no data were available regarding the individual type of stone surgery. Therefore, we cannot determine which procedure—URS or PCNL or SWL—had the highest impact on HRQOL. Nonetheless, we strongly believe that our findings highlight new important clinical variables that impact the HRQOL of kidney stone formers by leveraging the largest urolithiasis patient database available.

Conclusions

Our study demonstrates that older age at onset and longer duration of disease were independent predictors of better HRQOL in kidney stone formers. Additionally, longer time since the most recent surgery and longer time since most recent stone passage were independent predictors associated with better HRQOL in kidney stone formers.

Further studies should focus on optimizing stone-related modifiable risk factors to decrease the number of recurrent stone episodes and the need for recurrent surgical interventions.

Footnotes

Authors' Contributions

B.L.R. was involved in protocol/project development, data analysis, and manuscript writing/editing. C.D. and N.B. were involved in protocol/project development and manuscript writing/editing. S.K.B., R.L.S., S.Y.N., J.A.A., N.M.S., S.S., D.P.V., T.D.A., J.L., T.C., V.M.P., Jr., B.H.C., V.G.B., S.A., N.E.C., J.D.H., and K.L.P. were involved in manuscript writing/editing.

Author Disclosure Statement

T.D.A. is a consultant for Boston Scientific and Auris Medical.

N.B. is a consultant and investigator for Boston Scientific and Olympus.

No other authors have any relevant disclosures to report.

Funding Information

No funding was received for this article.

Supplementary Material

Supplementary Table S1

Abbreviations Used

References

Chen

, Prosperi

, Bird

. Prevalence of kidney stones in the USA: The National Health and Nutrition Evaluation Survey. J Clin Urol, 2019; 12(4):296–302; doi: 10.1177/2051415818813820.

Saigal

, Joyce

, Timilsina

, et al. Direct and indirect costs of nephrolithiasis in an employed population: Opportunity for disease management?. Kidney Int, 2005; 68(4):1808–1814; doi: 10.1111/J.1523-1755.2005.00599.X.

Chewcharat

, Curhan

Trends in the prevalence of kidney stones in the United States from 2007 to 2016. 2021; 49(1):27–39; doi: 10.1007/s00240-020-01210-w.

Penniston

, Nakada

. Health related quality of life differs between male and female stone formers. J Urol, 2007; 178(6):2435–2440; doi: 10.1016/j.juro.2007.08.009.

Penniston

, Antonelli

, Viprakasit

, et al. Validation and reliability of the Wisconsin stone quality of life questionnaire. J Urol, 2017; 197(5):1280–1288; doi: 10.1016/j.juro.2016.11.097.

Ahmad

, Tzou

, Usawachintachit

, et al. Low income and nonwhite race are strongly associated with worse quality of life in patients with nephrolithiasis. J Urol, 2019; 202(1):119–124; doi: 10.1097/JU.0000000000000233.

Penniston

, Nakada

. Treatment expectations and health-related quality of life in stone formers. Curr Opin Urol, 2016; 26(1):50–55; doi: 10.1097/MOU.0000000000000236.

Miyaoka

, Ortiz-Alvarado

, Kriedberg

, et al. Correlation between stress and kidney stone disease. J Endourol, 2012; 26(5):551–555; doi: 10.1089/end.2010.0536.

Bhojani

, Moussaoui

, Nguyen

, et al. Validation of the French version of the wisconsin quality of life (WISQOL) questionnaire for patients with nephrolithiasis. Can Urol Assoc J, 2020; 15(4); doi: 10.5489/CUAJ.6552.

10.

2018 Standard Occupational Classification System. Available from: https://www.bls.gov/soc/2018/major_groups.htm [Last accessed: August 24, 2021].

11.

Bureau of Labor Statistics

2010. SOC User Guide. Available from: https://www.bls.gov/soc [Last accessed: August 24, 2021].

12.

Defining Adult Overweight & Obesity | Overweight & Obesity | CDC. Available from: https://www.cdc.gov/obesity/adult/defining.html [Last accessed: August 24, 2021].

13.

Tapiero

, Limfuco

, Bechis

, et al. The impact of the number of lifetime stone events on quality of life: Results from the North American Stone Quality of Life Consortium. Urolithiasis, 2021; 49(4):321–326; doi: 10.1007/s00240-020-01238-y.

14.

Stern

, Gao

, Antonelli

, et al. Association of patient age and gender with kidney stone related quality of life. J Urol, 2019; 202(2):309–313; doi: 10.1097/JU.0000000000000291.

15.

Raffin

, Penniston

, Antonelli

, et al. The effect of thiazide and potassium citrate use on the health related quality of life of patients with urolithiasis. J Urol, 2018; 200(6):1290–1294. doi: 10.1016/j.juro.2018.06.023.

16.

R: The R Project for Statistical Computing. Available from: https://www.r-project.org [Last accessed: August 24, 2021].

17.

Penniston

, Sninsky

, Nakada

. Preliminary evidence of decreased disease-specific health-related quality of life in asymptomatic stone patients. J Endourol, 2016; 30(S1):S42–S45; doi: 10.1089/end.2016.0074.

18.

Diniz

DHMP

, Blay

, Schor

. Quality of life of patients with nephrolithiasis and recurrent painful renal colic. Nephron Clin Pract, 2007; 106(3); doi: 10.1159/000102995.

19.

Bensalah

, Tuncel

, Gupta

, et al. Determinants of quality of life for patients with kidney stones. J Urol, 2008; 179(6):2238–2243; doi: 10.1016/j.juro.2008.01.116.

20.

Pinquart

Health-related quality of life of young people with and without chronic conditions. J Pediatr Psychol, 2020; 45(7):780–792; doi: 10.1093/jpepsy/jsaa052.

21.

Bryant

, Angell

, Tu

, et al. Health related quality of life for stone formers. J Urol, 2012; 188(2):436–440; doi: 10.1016/j.juro.2012.04.015.

22.

Donnally

, Gupta

, Bensalah

, et al. Longitudinal evaluation of the SF-36 quality of life questionnaire in patients with kidney stones. Urol Res, 2011; 39(2):141–146; doi: 10.1007/s00240-010-0313-2.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB