Dr. Ziemba discusses post-op quality of life after ureteroscopy


"What we did find was that a preoperative ureteral stent, and when we did semi rigid ureteroscopy initially, seemed to be protective against worse symptoms," says Justin B. Ziemba, MD, MSEd.

In this video, Justin B. Ziemba, MD, MSEd, describes the background and notable findings from the Urology study “Post-Operative Recovery of Quality-of-Life Following Ureteroscopy for Nephrolithiasis: The Impact on Pain Intensity and Interference and the Ability to Participate in Social Roles.” Ziemba is Co-Chair of the UPHS Graduate Medical Education Subcommittee for Quality & Safety in the Clinical Learning Environment and an assistant professor of urology in surgery at the Hospital of the University of Pennsylvania, Philadelphia.


Please describe the background for this study.

Our group has been studying the lived experience of those undergoing surgical intervention for kidney stones for the past several years. Previously, outcomes related to surgical intervention have mostly been focused on our stone-free rate, how much stone we're getting out, which obviously is important. And then other factors: complication rates, revisits to the emergency department, hospital admissions, etc. But this was really a narrowed focus on the recovery and the outcomes that patients were hoping to achieve after their surgery. We know that kidney stone disease is largely a disease that impacts quality of life. And so that really has not been a focus until our group and a few others started looking into this several years ago. And so this is just 1 study that we have been working on in that line of work. And so that really drove us to understand the outcome that we looked at here.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

First, to set a little bit of the context, we utilized the PROMIS system, which is an NIH-developed bank of quality-of-life instruments and questionnaires that were developed several years ago, and have been used in other disease states outside of urology as well within, and so they're really psychometrically robust; they have good validity. And so that's what we had focused on. For this specific study, we looked at pain intensity, which is a measure of that traditional 1 to 10 pain that we think about being at its average or worse. But these other concepts such as pain interference, which is like how is that pain interfering with enjoyment of life activities, or close personal relationships, and then ability to participate in social roles, which is trouble doing all your normal work at home or at work itself, or limitations on family activities. Those were the kinds of instruments and dimensions we looked at here in this study. And for the results specifically, not surprisingly, we saw that right after surgery, there was quite an acute and severe worsening of quality of life, particularly from that day 0 to that day 1 right after surgery. And then that sort of also continued up until about day 7. And then at that 7-day mark, we see a switch or an inflection point where people start to improve. Now, what is most interesting I would say is that the peak for these measures was almost exclusively in that first day, if not, certainly that first week. But people were quite terrible on that first day or 2. Some people did continue to get a little bit worse throughout the course of that week. But like I said, at that 7-day mark, things started to improve substantially. And then if we look out to the end of our study at 30 days, people were doing better than they were preoperatively. The other interesting thing was that we saw an almost four fold improvement in all these measures. So people did significantly worse. and then they improved, like I said, well above their baseline, which is for this instrument, quite substantial to have a four fold increase. That is massively clinically significant, meaning it's really perceptible by the patients. I would say some other interesting findings, that traditionally people have thought were really going to be big impact on quality of life, which is this postoperative ureteral stent. We did some analysis and found that the post operative ureteral stent did not seem to impact these recovery trajectories, which is somewhat interesting. And when we looked at the factors that may be associated with post operative recovery and we looked at the post op day 1 specifically to see if we could identify people who would have severe symptoms, and it turned out that a postoperative stent there, as well as patient demographic factors were not really associated with any of those changes. What we did find was that a preoperative ureteral stent, and when we did semi rigid ureteroscopy initially, seemed to be protective against worse symptoms. And so we theorized that that was probably due to the preoperative ureteral stem being present and changing people's perception of what the recovery was going to be because they already kind of had some of those symptoms entering into the surgery. And then the semi rigid ureteroscopy was like a proxy for a lowercase complexity. And so those things kind of stood out to us and were significant.

This transcription was edited for clarity.

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