The trends in the prevalence of urolithiasis in Asian subcontinent show a variable response with overall prevalence of 1–5% while some Asian countries like Saudi Arabia have also reported prevalence up to 20.1% (14). Pakistan being situated in the middle of Afro-Asian stone forming belt show a high incidence of kidney stone formation with study reporting urolithiasis workload of 40–50% in the urological settings of Pakistan (15). Quality of life of kidney stone formers has been a concern in this regard. HRQoL in kidney stone patients have been assessed in different urologic setting in different regions of the world but to the best of our knowledge this is first attempt to assess the HRQoL of stone formers using disease specific instrument in native community with such vast ethnic inclusiveness.
Study reveals that quality of life of stone formers is affected as kidney stone formers scored lower than healthy study participants in all the major domains of HRQoL i.e. social, emotional, disease impact and vitality. These results are consistent with Bryant and Micheal (2) who also reported same finding using SF 36 questionnaire.
Results indicated an age related decline in the HRQoL of kidney stone formers as shown in Fig. 1, similar findings were reported by Arafa and Mostafa (5). That is particularly true for age, this decline in QoL of stone formers with advancing age can be attributed to the compromised ability of coping with the emotional and physical trauma associated with kidney stone disease. On contrary the pediatric stone formers scored very high in all the domains of WISQoL as depicted in Fig. 1, More evidences are needed to support the argument that either urolithiasis does not compromise the HRQoL of pediatric stone formers to the extent the QoL of other age groups is affected or the appropriateness of WISQoL for this particular age group need to be addressed as WISQoL was originally validated for adult stone formers.
A gender related difference was observed in the HRQoL of stone formers, female stone formers scored lower than male stone formers in all the WISQoL domains i.e. standard score (54.3 vs 50.8), social impact (57.0 vs 51.2), emotional impact (56.5 vs 53.3), disease impact (51.6 vs 50.0) and impact on vitality ( 41.6 vs 34.8), similar results were reported by Penniston and Nakada (7) who evaluated the difference between the HRQoL of male and female stone former using a generic instrument.
Clinical features of kidney stone disease were also observed as markers of HRQoL. Among diseases feature patients having stone localized at more than one site in the body (for example, patients having a stone in kidney and ureter at the same time) scored lowered in WISQoL domains than those with stone localized at a single site (either kidney, ureter or bladder). Moreover, stone type (either staghorn stone or non-staghorn stone) also yielded a statistically significant association with the HRQoL. Arafa and Mostafa (5) in their study also reported a significant relation of stone location and stone size with the HRQoL of urolith formers, However, in our study, a statistically insignificant association was found with the kidney stone size. Although stone formers having larger stone within their body scored lower in major domains of WISQoL (52.7 vs 50.9 for the standard score, 55.3 vs 49.5 for emotional impact and 51.0 vs 46.9 for disease impact) while almost similar and converse results were observed in social impact (54.1 vs 54.9) and impact on vitality ( 37.9 vs 45.2) respectively. This difference may be due to the accommodation process involving response shift that results in a change in internal standard and values (16).
Interestingly the patient’s perception of current stone status showed contradictory results, as patients who reported that they do not currently have stone within their body scored lower in WISQoL domains (standard score; 54.5 vs 46.3, Social impact; 55.8 vs 48.8, emotional impact; 58.1 vs 44.4, disease impact; 53.2 vs 42.7, impact on vitality; 38.0 vs 39.4) compared with those who reported the presence of stone within their body. These contradictory results can be accredited to the fact that patients who responded were asked about their perception for the stone presence within their body a couple of days after surgery, so the hospital stay, post-surgical impairment and stent placement (17) maybe associated with the current finding. Further the fact the complete stone free status is achieved by patients a couple of weeks after surgical intervention also supports the current finding. Notably procedure for active removal of stone was critical for determining the patient's HRQoL. Depending on clinical features of disease different surgical techniques including PCNL, URS, Pyelolithotomy, cystolithotomy, and open surgery were used for active stone removal, findings report a statistically significant relation of surgical procedure with WISQoL domains. Patients receiving different minimally/partially invasive procedures (e.g. PCNL and URS) for active stone removal scored better than patients who were subjected to invasive or completely invasive surgical procedures like pyelolithotomy, cystolithotomy or laparoscopic procedures respectively.