Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure.

PURPOSE: We developed the ureteral stent symptom questionnaire (USSQ), a psychometrically valid measure to evaluate symptoms and impact on quality of life of ureteral stents. MATERIALS AND METHODS: A total of 309 patients were asked to participate during different phases of our study. In phase 1 a structured literature search, 9 patient interviews and studies of 90 patients using existing instruments formed the foundation for the initial draft of our new questionnaire. In phase 2 the USSQ was pilot tested, reviewed by experts and field tested in 40 patients to produce a final 38-item draft. In phase 3 formal validation studies were performed in 55 patients to assess validity, reliability and sensitivity to change. Discriminant validation was performed by administering the questionnaire to 3 groups of patients without stents. RESULTS: The final draft addressed various domains of health (6 sections and 38 items) affected by stents covering urinary symptoms, pain, general health, work performance, sexual matters and additional problems. The validation studies showed the questionnaire to be internally consistent (Cronbach's alpha > 0.7) with good test-retest reliability (Pearson's coefficient > 0.84). The questionnaire demonstrated good construct validity and sensitivity to change shown by significant changes in the score with and after removal of stents. The new USSQ discriminated patients with stents from healthy controls (p < 0.001) and patients with urinary calculi without stents and lower urinary tract symptoms. CONCLUSIONS: Indwelling ureteral stents have a significant impact on health related quality of life. The new USSQ is a valid and reliable instrument that is expected to become a standard outcome measure to evaluate the impact and compare different types of stents.

Characterization of urinary symptoms in patients with ureteral stents.

OBJECTIVES: To prospectively assess the prevalence and bother of various urinary tract symptoms caused by indwelling ureteral stents using validated questionnaires. METHODS: The study consisted of 60 patients with unilateral ureteral stents. Of these, 30 patients were asked to complete the International Prostate Symptoms Score questionnaire, with additional questions on dysuria, hematuria, and loin pain. The remaining 30 patients were asked to complete the International Continence Society questionnaire. These patients were also asked to complete frequency volume charts and undergo uroflowmetry studies. The questionnaires were completed with a stent in situ and 6 weeks after its removal. RESULTS: Forty-eight patients (36 men and 12 women, mean age 52.8 years) completed the study. A large proportion (80%) of patients reported one or more urinary symptoms. Analysis of the IPSS data revealed impaired global quality of life owing to these urinary symptoms. The responses to additional questions on dysuria and hematuria showed a statistically significant difference, but most International Prostate Symptoms Score questions did not. The results of the International Continence Society study identified storage symptoms, incontinence (60%), and bladder pain (80%) as important bothersome problems. The results of the frequency volume charts were in agreement with the storage symptoms. CONCLUSIONS: Patients with indwelling ureteral stents have a wide range of urinary symptoms that affect their quality of life. Storage symptoms, bladder pain, and hematuria pose a major bother. None of the existing questionnaires covered the entire range of symptoms. The results are useful in better understanding the urinary symptoms associated with stents and in providing patient counseling.

The development and validation of a patient-information booklet on ureteric stents.

OBJECTIVE: To report a scientific approach incorporating patient preferences towards the development of a patient-information booklet about ureteric stents. PATIENTS AND METHODS: Phase 1 of the study included 35 adult patients with ureteric stents who were surveyed using semi-structured interviews (four patients) and a questionnaire (31 patients) to assess various issues relating to information given to patients about ureteric stents. In addition, published papers were assessed and clinicians' opinions sought. The results formed the basis for a comprehensive patient-information booklet about ureteric stents that incorporated patients' views and preferences. In phase 2, the booklet was tested and formally validated by inviting 30 patients, a panel of 20 urologists and general practitioners, and five stent manufacturers to assess the booklet for adequacy, coverage and readability of the content. RESULTS: Of the 35 patients, 30 (19 men and 11 women, mean age 49 years, range 20-78) participated in the initial survey; 80% of patients reported dissatisfaction about the information they received. Patients wanted more information about the use, adverse events and effects of stents on daily life; 85% preferred all relevant information about the stents to be in a written format with illustrative drawings. An eight-page booklet was thus developed. The validation study revealed that the booklet matched patients' experiences (approval score of 9/10, range 8-10) and was reported as satisfactory by clinicians and manufacturers. CONCLUSIONS: A validated information booklet on ureteric stents was developed, incorporating patients' expectations and views. This booklet is expected to be an effective tool for patient communication that would help patients cope better with indwelling stents and be useful in counselling patients. A similar approach could be adopted for the development of other patient-information packs.