Stone disease and QoL issues

Stone disease and QoL issues

Experts clarified issues on stone diagnosis, prevention and treatment and the recurring message among the speakers was the tendency of urologists to lumped together patients in one category despite the subtle-  and yet crucial- differences in their disease and individual needs.

Chaired by Prof. Thomas Knoll (DE), Thematic Session 1 featured three state-of-the-art lectures that tackled basic research on stone formation, quality-of-life (QoL) issues, recommendations for metabolic evaluation and an update session in the form of a point-counterpoint debate. “Stone formation is complex and we need a deep understanding of issues such as metabolic evaluation,” said Knoll.

Speaker Prof. Manoj Monga (US) of the American Urological Association (AUA) spoke on QoL and noted that patient’s perception of QoL differs than that of the doctor or healthcare professionals, a difference which, when misunderstood, can lead to inappropriate care.

“There are differences in perception, and people in the same situation will assess their quality of life based on economic, social, health, independence and other factors,” Monga said. He added that having an awareness of the patient’s viewpoint will enable urologists to better respond to issues such as pain symptoms, dietary needs and a drug plan that is appropriate.

Prof. Oliver Traxer (FR) brought home the message that metabolic evaluation is often taken for granted by urologists but having a good grasp of the basics such as urine analysis and diet can make a big difference in preparing an effective treatment plan. According to Traxer, different types of stones require different types of approaches since a dietary advice for a patient with a uric acid stone may not necessarily fit a patient suffering from cystine stones. Traxer stressed the importance of taking a proper urine collection and also noted that a metabolism check-up is highly recommended for a calcium load test and bone density.

Traxer’s general recommendations for stone formers include regular water consumption (2 to 2.5 litres per day), a limit on calcium and sodium intake, and for certain stone formers a restriction on oxalate and uric acid food intake.

During the debate between Prof. Thorsten Bach (DE) and Prof. Andreas Skolarikos (GR) regarding the need for a specific work-up for patients, Skolarikos argued about the benefits and said that despite the lack of solid scientific evidence, preventive treatment is better than the lack of a non-selective approach.

Bach’s contrary opinion only emphasized fluid intake, and in case of recurrence the use of endourological treatment but not pharmacology since even the few drugs recommended for recurrent stone-formers are not effective due to poor compliance by patients.