Patient decision making for asymptomatic renal calculi: balancing benefit and risk.

Abstract

OBJECTIVE:

To evaluate which variables affect patients' decisions on the management of asymptomatic renal calculi.

MATERIALS AND METHODS:

We hypothesized that patients who had experienced greater pain, passed larger or more stones, or passed stones more recently would be more likely to choose surgical intervention (ureteroscopy [URS] or shock wave lithotripsy [ESWL]) instead of observation (OBS). The survey was distributed to 101 patients in our stone clinic. The patients were given a hypothetical scenario of an asymptomatic 8-mm lower pole stone and descriptions for OBS (annual radiography, 40% chance of growth >10 mm within 4 years, 20% chance of passage), ESWL (65% success rate), and URS (90% success rate, with stent placement for 1 week). The patients were also asked whether they would rather defer the decision to their physician.

RESULTS:

Of the patients, 22.8% chose OBS, 29.7% chose URS, and 47.5% chose ESWL. The patients who had passed larger stones (P = .029) were less likely to choose OBS over surgery. Of the 78 patients who chose intervention, 61.5% preferred ESWL. The patients were more likely to choose URS if they had previously undergone URS (P = .0064) and stent placement (P = .048), and the patients were more likely to choose ESWL if they had a previously undergone ESWL (P = .019). Surgical choice was not affect by size of the largest stone passed (P = .46), date of last passage (P = .080), previous pain intensity (P = .11), previous percutaneous nephrolithotomy (P = .73), or number of stones passed (P = .51). Finally, 56.4% of patients deferred the decision of the treatment approach to the physician.

CONCLUSION:

Previous stone experience and treatment significantly affected treatment choice. Patients rely on their physician to educate them on the alternatives and play an active role in selecting the treatment approach.

• Authors: Carl Sarkissian, Mark Noble, Jianbo Li, Manoj Monga
• Journal: Urology (Urology) Vol. 81 Issue 2 Pg. 236-40 (Feb 2013) ISSN: 1527-9995 [Electronic] United States
• PMID: 23374767 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Asymptomatic Diseases (therapy)
• Decision Making
• Humans
• Kidney Calculi (complications, pathology, therapy)
• Lithotripsy
• Pain (etiology)
• Patient Participation (psychology)
• Patient Preference (psychology)
• Random Allocation
• Recurrence
• Risk Assessment
• Severity of Illness Index
• Surveys and Questionnaires
• Ureteroscopy
• Watchful Waiting