We have discussed the different treatment options for urinary calculi . While there are a few number of studies addressing the HRQoL in different surgical options or in MET , there are even less investigations that address the HRQoL comparing surgical vs. pharmacotherapy vs. dietary intervention of urinary calculi .

Studies comparing HRQoL in surgical options have found conflicting conclusions. While some studies show favorable outcomes for SWL [33, 44], others have found the HRQoL between SWL and PNL to be comparable [31, 32]. Additionally, while there has been SWL popularity in some studies [33, 45], it has been concluded that HRQoL is negatively affected by those patient with residual fragments [43]. And though the HRQoL is largely influenced by the size of those fragments, it is still important to bear in mind their undesirable impact.

Staios et al. prospectively evaluated 22 patients undergoing PNL [46]. They were administered SF-36 before the procedure and again 6 weeks after PNL . While there was an overall improvement of HRQoL, only two of the domains saw statistically significant difference. They concluded that, despite a high stone-free rate (87%), less than half of the patients were found to have benefited subjectively from PNL [46].

Kuo et al. surveyed a group of stone formers to compare surgical vs pharmacotherapy. They were able to observe a preference for a quick and painless solution, which equated to SWL intervention for mild pain [44]. However, patients who had undergone more stone retrievals, or who were further out from their last stone event, were more apt to avoid surgical intervention and choose long-term medical therapy. These findings were similar to the additional results from Bensalah et al. study in 2008 [41] where they found the number of URS procedures as well as stent placement to negatively impact mental well-being. They also found a favorable association with HRQoL with medical therapy, particularly with potassium citrate [41].

A recent Internet-based survey , with a non-validated questionnaire, assessed general satisfaction in 443 patients who had undergone all intervention strategies for an acute stone [47]. Those strategies included surgery, pharmacotherapy, home remedy (dietary intervention), as well as observation for spontaneous passage. While a majority of patients (51%) reported “success of treating stones” for being the reason they liked their treatment method, there were 37% of patients who were favorable to their treatments due to QoL factors such as avoiding surgeries or hospitalizations as well as appreciation for quick recovery times.

While there are no studies that formally investigate HRQoL in medically or nutritionally treated stone formers, much less ones that compare them to non-stone-forming individuals, there are certain aspects that can be taken from complications and withdrawal rates from their trials. Two pharmacotherapy trials not only had a majority of their studies with higher relative risk (RR) of withdrawal rates when compared to the control group, but they had higher RR of withdrawal due to adverse events [19].

In the investigations of dietary intervention trials, only one of eight studies reported any adverse events. And while one study had a higher RR of withdrawal when compared to the control group, there were none that found higher RR of withdrawal due to adverse events [19].

There are still many HRQoL aspects of nephrolithiasis management that need to be further investigated so that we might be able to improve patient outcomes, and newer evaluation tools, such as the Wisconsin Stone-QoL instrument, will allow even better insight into methods to improve the QoL in our patients. However, what may be gleaned from the currently available information is that:

With the increasing awareness of patient-reported outcomes, more attention is being given to HRQoL. Perhaps, in order to improve HRQoL, endpoints for acute stone management should not only address physical domains such as stone-free status and pain scores but should also strive to positively impact the mental health, emotional well-being, and social functioning of the patient.

Additionally, maybe the long-term management of this chronic disease could include more than simply screening for recurrence and counseling for future prevention; perhaps a team outside urology could be collaborating in order to monitor and manage the domains of mental health, emotional well-being, and social functioning.