The effect of shock wave lithotripsy and retrograde intrarenal surgery on health-related quality of life in 10-20 mm renal stones: a prospective randomized pilot study.

The effects of treatment modalities such as retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) on health-related quality of life (HRQoL) were determined in patients with renal stones between 10 and 20 mm. A total of 120 patients were included in the study and prospectively randomized to RIRS or SWL group. A total of 39 patients experienced treatment failure and finally 81 patients (45 patients in the RIRS group, 36 patients in the SWL group) were analyzed for HRQoL. SF-36 survey was used to determine HRQoL pre-operatively, post-operative day 1 and 1 month. The patient and stone characteristics such as age, gender, stone size, grade of hydronephrosis and body mass index were similar between the two groups. At post-operative day 1, the RIRS group was associated with lower scores of role functioning/physical (p = 0.008), role functioning/emotional (p = 0.047) energy/fatigue (p = 0.011), social functioning (p = 0.003) and pain (p = 0.003) when compared to the SWL group. At post-operative 1 month, only pain and emotional well-being scores (p = 0.012 and p = 0.011, respectively) in the RIRS group were statistically lower according to the SWL group. In our study, patients in the SWL group showed more favorable HRQoL scores when compared to the patients in the RIRS group in short-term follow-up.

Role of Complementary Medicine (Music, Acupuncture, Acupressure, TENS and Audio-Visual Distraction) in Shockwave Lithotripsy (SWL): A Systematic Review From EAU Sections of Urolithiasis (EULIS) and Uro-Technology (ESUT).

We performed a systematic review to look at the role of alternative or complementary medicine such as music, acupressure, acupuncture, transcutaneous electrical nerve stimulation (TENS) and audiovisual distractions to decrease analgesia requirement and alleviate anxiety during SWL. Twenty-three papers(2439 participants) were included: Music (n = 1056.6%), Acupuncture (n = 517.7%), Acupressure (n = 13.8%), TENS (n = 617.2%), and audiovisual distraction (n = 14.6%). Most of the studies showed that complementary therapy, lowered pain, and anxiety with higher patient satisfaction and willingness to undergo the procedure. With its feasibility and convenience, urological guidelines need to endorse it, and more should be done to promote its use in outpatient urological procedures.

Effect of Different Musical Types on Patient's Relaxation, Anxiety and Pain Perception during Shock Wave Lithotripsy: A Randomized Controlled Study.

PURPOSE: The aim of this study was to investigate the effects of listening to different music types during extracorporeal shock wave lithotripsy (SWL) on the patients' pain control, anxiety level, and satisfaction. MATERIALS AND METHODS: This study was a prospective single-blinded, paral-lel-group randomized clinical trial with balanced ran-domization [1:1]. A total of 150 patients who underwent first-session SWL were included in the study. The patients were randomly divided in to five groups (30 participants in each group) as follows: headphones were not put on and no music was played in Group 1 (control group); headphones were put on but no music was played in Group 2; Turkish art music was listened to with headphones in Group 3; Western classical music was listened to with headphones in Group 4; thetype of music the patient liked was listened to with headphones in Group 5. Demographic data related to patients and procedure, State-Trait Anxiety Inventory-State Anxiety (STAI-SA), Visual Analog Scale (VAS) scores, willingness to repeat procedure (0: never 4: happily), and patient satisfaction rates (0: poor 4: excellent) were recorded immediately after the procedure. RESULTS: There was a statistically significant difference between groups in terms of median VAS scores (7, 6, 4.5, 5, and 4, respectively, P<.001), whereas the VAS scores in Groups 3, 4, and 5 were significantly lower than those in Group 1 and 2 (P<.001). The median STAI-SA scores between the groups were significantly different (45, 45, 42, 45, and 40, respectively, P<.001), while the anxiety levels in Groups 3, 4, and 5 were significantly lower than those in Group 1 (P=.008, P=.018, and P<.001, respectively). Moreover, there were statistically significant differences between the groups in terms of willingness to repeat the procedure and patient satisfaction rates (P<.001). CONCLUSIONS: Music therapy during SWL reduced the patients' pain and anxiety scores, moreover listening to the patient's preferred music type provided greater satisfaction. Listening to the patient's preferred music type could be standardized and routinely used during SWL.

Frequency of anxiety and depression in patients of urtolithiasis undergoing Extracorporeal Shock Wave Lithotripsy in Diyarbakir, Turkey.

Extracorporeal shock wave lithotripsy (ESWL) can cause depression and anxiety for patients with urolithiasis. We evaluated the frequency of anxiety and depression in patients of urolithiasis undergoing ESWL. Thirty patients scheduled for ESWL were enrolled in Diyarbakir State Hospital, Turkey. VAS-A, APAIS, BDS and BAS scores were recorded. The patients comprised 23 males and 7 females (M/F: 3.3/1 with a mean age of 31.03 } 10.84 years. The mean VAS-A were 5.46 } 1.71. The pre-procedural anxiety were 100% (VAS-A>0) and depression of 56.6% of patients. The statistically significant difference was observed in total APAIS scores betweeen male and females. (p=0.41) There was no significant difference between the groups in terms of gender and marital status (p< 0.05), Positive and statistically significant correlation was found between anxiety level (APAISa) and requirement of knowledge (APAISk) (p< 0.05). We found that depression and anxiety rates were high in patients with ESWL procedure.

Listening to music during shock wave lithotripsy decreases anxiety, pain, and dissatisfaction : A randomized controlled study.

BACKGROUND: We analyzed the effects of music on pain, anxiety, and overall satisfaction in patients undergoing a shock wave lithotripsy (SWL) procedure. METHODS: A total of 200 patients scheduled to undergo SWL were included in this study. Group 1 consisted of 95 patients who listened to music during the SWL session while group 2 included 105 patients who did not listen music during the procedure. State-Trait Anxiety Inventory (STAI) was used to assess state and trait anxiety (STAI-S/T). A visual analog scale (VAS) was used at the end of the session in order to assess pain, willingness to repeat the procedure, and overall patient satisfaction. Hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded before and after the session. RESULTS: No statistically significant difference was found between the two groups in terms of stone characteristics, SWL parameters, pre-SWL STAI-T/S scores, and pre-SWL hemodynamic parameters. Post-SWL STAI-S scores were found to be lower in patients who listened to music (p = 0.006). At the end of the SWL, VAS scores of pain, satisfaction, and willingness to repeat procedure were significantly different in favor of the music group (p = 0.007, p = 0.001, p = 0.015, respectively). SBP, DBP, and HR were significantly higher in patients who did not listen to music (p = 0.002, p = 0.024, p = 0.001, respectively). CONCLUSION: Music can be an ideal adjunctive treatment modality for patients undergoing SWL treatment. It has the potential to enhance patient compliance and treatment satisfaction by reducing the procedure-related anxiety and pain perception.

Shared decision making: why do patients choose ureteroscopy?

To evaluate patient's characteristics that affects their decision on the management of asymptomatic renal calculi, and to determine the impact of anesthetic on the selection of shockwave lithotripsy (SWL). A survey was distributed to 100 patients in our multi-disciplinary stone clinic. The patients were given a hypothetical scenario of an asymptomatic 8 mm lower pole stone and descriptions for managements options including active surveillance (annual radiography, 40% chance of growth >10 mm within 4 years, 20% chance of passage), SWL under conscious sedation (65% success rate), and URS (90% success rate, with stent placement for 1 week). Patients were asked what was the most important variable impacting the choice of treatment. Patients preferred SWL (45%) over URS (32%) and active surveillance (23%). Patients with a previous experience with URS were more likely to choose it again (p = 0.0433). Decisions were driven primarily by success rate (52%), followed by risk of complications (29%), postoperative pain (7%) and others (12%). Patients choosing URS had the highest magnitude of history of pain (p = 0.03) and were more likely to prioritize success (78%) and less likely to prioritize surgical risk (13%) or anticipated pain after surgery (0%) (p = 0.01). Most (85%) of the patients would rely on the physician's recommendation for the treatment modality. Patients place differing value on risk versus success. As they rely heavily on the physician's recommendation, it is important that their urologist determine whether risk or success is of highest priority for them to facilitate a shared medical decision.

Do the residual fragments after shock wave lithotripsy affect the quality of life?

OBJECTIVE: To evaluate the possible effects of residual fragments on the health-related quality of life in patients undergoing extracorporeal shockwave lithotripsy for renal stones. PATIENTS AND METHODS: Seventy-one patients with residual fragments were divided into 2 further groups; group 1 (n = 42; fragment size, ≤ 4 mm) and group 2 (n = 29; fragment size, >4 mm). During 3-month follow-up, spontaneous passage rates; number of emergency department visits, amount of the analgesic required, additional procedures, and the changes in the quality of life were evaluated. Quality of life was evaluated using the Short Form 36 survey. Statistical analyses included independent sample t tests. RESULTS: Of the 42 cases with fragments ≤ 4 mm, although 92.8% patients passed the fragments spontaneously, fragments resided until 3 months in 4.8% patients. Again, after 2 sessions of extracorporeal shockwave lithotripsy, of the 29 cases with fragments >4 mm, 55% were stone free, whereas 14% still had residual fragments. Mean number of emergency department visit was found to be 0.07 and 0.5 in both groups, respectively. Mean analgesic need was 138.75 mg in group 1 and 375 mg in group 2. Although significantly lower scores were noted only for one parameter during 1-month evaluation in cases with larger fragments, they were present in all 8 parameters during 3-month evaluation. CONCLUSION: Larger residual fragments could significantly affect the quality of life. Emergency department visits and colic attacks are the causes of discomfort. Effective stone disintegration by an experienced urologist should be aimed to limit the negative effects of residual fragments on the quality of life.

Auricular acupressure as a treatment for anxiety before extracorporeal shock wave lithotripsy in the elderly.

PURPOSE: Auricular acupuncture at the relaxation point has been shown to be effective treatment for anxiety. We hypothesized that auricular acupressure may decrease anxiety in elderly individuals who are transported by ambulance before receiving ESWL. MATERIALS AND METHODS: We enrolled 100 patients with renal calculi who were transported to the local hospital by special ambulance, accompanied by 2 paramedics. Paramedic 1 performed data collection, while paramedic 2 performed auricular acupressure in patients randomly assigned to a relaxation group and a sham treated group. Anxiety was measured using a visual analog scale score on a scale of 0 to 100 mm. RESULTS: Each group consisted of 50 patients with similar demographic characteristics. The relaxation group had significantly decreased anxiety scores upon arrival at the hospital and lower anticipation of pain scores (mean+/-SD 57.6+/-21.8 to 15.4+/-9.8 and 35.7+/-29.7 to 9.5+/-4.1 mm VAS) than the sham treated group (55.5+/-25.9 to 49.8+/-28.9 and 37.7+/-24.1 to 33.8+/-25.2 mm VAS, respectively, 2-way repeated measure ANOVA each p=0.001). Estimated waiting times for treatment did not differ significantly between the 2 groups (5.0+/-2.5 and 5.5+/-2.95, respectively, repeated measures ANOVA p=0.83). The Post-Intervention Anxiety visual analog scale demonstrated the significant superiority of the true treatment group (19.5+/-5.9 and 66.8+/-27.9 mm VAS, respectively, p=0.001). CONCLUSIONS: Elderly patients who received auricular acupressure at specific relaxation points while being transported to the hospital were less anxious, anticipated less pain and were more optimistic about the outcome of treatment that they will receive than the sham treated group. These data prove that this is an effective treatment for anxiety that improves the patient overall perception of ESWL.

What is important to patients receiving extracorporeal shock-wave lithotripsy for urinary tract calculi?

INTRODUCTION: Patients' experience and expectations are paramount in the current era of clinical governance. However, there is lack of published information on patients' expectations from extracorporeal shock-wave lithotripsy (ESWL) treatment for renal stone disease. We conducted a survey to quantify what aspects of ESWL are important purely from the patients' prospective. PATIENTS AND METHODS: Postal questionnaires were sent out to all patients who attended our unit for ESWL treatment for renal stone disease. The questionnaire referred to 15 aspects of ESWL treatment. Patients were asked to rate each aspect based on a numerical scale from 1 to 10 (1--least important; 10--most important). RESULTS: We posted 340 questionnaires and received 208 valid replies (61%). Stone clearance was statistically the most important aspect of treatment. Staff attitude and explanation of the procedure and outcomes were rated highly. To our surprise, pain control was rated only 8th. CONCLUSIONS: Patients' priorities may be different to ours. Surveys like this allow ones to put the appropriate 'weight' on the results of patient satisfaction surveys in order to allocate resources and improve service appropriately.

Do patients expect too much from extracorporeal shock wave lithotripsy?

BACKGROUND: The era of patient-focused care has brought a new dimension to medical treatment. Now, as well as looking for therapies that work effectively, they must also be acceptable to patients. Previous studies in this department have shown that stone clearance rates with lithotripsy compare favourably with national standards, but very little work has been done regarding patient's own perception of the experience. METHODS: A postal survey was conducted of all patients attending the lithotripsy unit over a period of 1 year, questioning their opinion of all aspects of the treatment. The results were analysed by conversion to a numerical score. RESULTS: On the whole, patients expressed satisfaction, but they were more dissatisfied with the stone clearance than any other aspect of their treatment. In the light of a previous study, it was felt that the patients' expectations were unrealistic. As a result, we changed our practice such that patients attending the unit have a better idea of the likelihood of success. CONCLUSIONS: This was a simple and cost-effective exercise, that has generated some valuable data which can be used to improve the entire patient experience.

[Extracorporeal shock-wave lithotripsy: anxiety and pain perception]. / Litotricia extracorpórea por ondas de choque: ansiedad y percepción del dolor.

UNLABELLED: Three factors in extracorporeal shock-wave lithotripsy (ESWL) result in pain: shock wave pressure, size of focal area and pressure distribution at entry in the skin. Our Lithotripsy Unit has performed 21,000 outpatient treatments (Dornier HM-4 Lithotripter) with no sedation or anaesthetics. Pain requiring treatment discontinuation resulted in 10% instances. Anxiety-associated pain increases the perceived intensity of pain and influences the emotional response to pain. OBJECTIVE: To determine whether the variability in the response to the pain stimulus caused by ESWL is related to the patient's status/trait of anxiety. METHOD: Sample 20 patients; inclusion criteria: pyelic lithiasis > 2 cm, no previous SWEL and no obesity. One SWEL session (2500 pulses, 22 Kv). Anxiety was first evaluated using the status/trait of anxiety index (STAI) questionnaire; after treatment, pain was evaluated on a Numerical Analogic Scale. RESULTS: Pain scores ranged from 2 to 8, mean score 4.1 (S.D. = 1.67); mean score for trait of anxiety 21.8 (S.D. = 8.52), and status of anxiety 29 (S.D. = 5.89). A significant correlation was found between pain-anxiety trait (R = .51; p = .02), which was higher when compared to pain-anxiety status (R = .67; p = .001). CONCLUSIONS: SWEL is a painful therapy (95% of sample had mild-to-moderate pain); pain perception is increased by status of anxiety (45% of pain variance) more than by the trait of anxiety (26.3%); therefore, usage of sedation-analgesia in patients with high anxiety status would improve the lithotripter efficacy ratio.

Anxiety and patient participation in clinical decision-making: the case of patients with ureteral calculi.

Ninety-six patients with a ureteral calculus participated in a study whose purpose was to identify those subjects who would benefit from participation in clinical decision-making. Forty-two of the subjects (the experimental group) were given information about two alternative treatments, Extra Corporeal Shock Wave Lithotripsy (ESWL) and ureteroscopy, and were asked to choose which therapy they preferred. Fifty-four subjects (the control group) were not given information, not allowed to choose, and were treated according to the physician's decision. Subjects' level of anxiety was compared within each group on three occasions: before meeting with the physician, immediately afterwards and upon hospitalization for treatment of the stone. Patients perception of receipt of information and participation in clinical decision-making, coping style, educational level, and knowledge about treatment alternatives were also measured. A statistically significant decrease in anxiety after meeting with the urologist was found among patients who were not asked to participate in the decision-making process and among patients who perceived that they had received information. A decrease in anxiety after meeting with the physician was also found among patients who, according to their own perception, did not participate in decision-making. Patients' educational level and coping style were related to their anxiety. A decline in anxiety was found among those with a lower educational level who perceived that they had received information and among higher educated patients who perceived that they participated in clinical decision-making. Anxiety also declined among patients with a passive coping style who perceived that they had received information or had participated in the decision-making process. The results emphasize the need to tailor the therapeutic approach to patient characteristics.

Quality of life after treatment of gallstones: results of a randomised study of lithotripsy and open cholecystectomy.

OBJECTIVE: To compare quality of life after extracorporeal shock wave lithotripsy (ESWL) and open cholecystectomy for symptomatic gallstones. DESIGN: Randomised study. SETTING: University hospital, The Netherlands. SUBJECTS: 49 Patients, 23 of whom were randomized to undergo ESWL and 26 to undergo open cholecystectomy. INTERVENTIONS: Health questionnaires were filled out before, and at 3, 6 and 12 months after treatment. MAIN OUTCOME MEASURE: Improvements of quality of life after one year. RESULTS: Both treatments improved quality of life. Open cholecystectomy improved quality of life significantly better than ESWL (median percentage gains in Nottingham Health Profile scores at 1 year 17.1 and 10.5, respectively, p = 0.003). CONCLUSION: Open cholecystectomy is superior to ESWL in improving quality of life, so cholecystectomy remains the treatment of choice for symptomatic gallstones. For patients who are unfit or unwilling to undergo operation, however, ESWL is adequate because most patients have some benefit from it in terms of quality of life.

Peri-operative anxiety in patients undergoing extracorporeal piezolithotripsy.

Twenty-four patients undergoing extracorporeal piezolithotripsy took part in this study and underwent treatment on a Wolf Piezolith 2300 Lithotripter, which does not require any type of anaesthesia and enables the patient to be treated as an out-patient. Previous work has investigated anxiety states of patients during investigative procedures and found that information given prior to the procedure is beneficial in reducing the levels of anxiety reported. Modern urological surgery carried out to remove kidney stones has progressed to non-invasive techniques with the introduction of extracorporeal piezolithotripsy (EPL). However, little work has examined the patient's reaction to this new procedure. Since patients undergoing EPL are awake throughout the procedure, it is possible to perform continuous assessment of anxiety by measurement of palmar sweat. The results demonstrated significantly increased levels of palmar sweat throughout treatment, with a return to pre-treatment levels afterwards. This was demonstrated by just under 50% (n = 10) of patients who appeared to be agitated during treatment, and by the comments made by patients about their treatment. One-third of patients (n = 8) described pain as far more severe than had been anticipated when asked if they could identify a cause for anxiety. It is recommended that adequate patient preparation and education prior to the procedure should be provided, but that such education must also include a warning that some discomfort may occur.

Quantitative measurement of anxiety in patients undergoing surgery for renal calculus disease.

The anxiety experienced by patients undergoing surgical procedures is well documented and may affect the outcome of any operation. This has not been considered in modern urological surgery which is moving away from highly-invasive techniques towards minimal and even non-invasive procedures. Little work has been carried out to examine the patient's reaction to this new technology. This work has two aims: to assess patient anxiety before and after different procedures for renal calculus removal and to identify, where possible, factors that contribute to pre- and post-operative anxiety. The main method of quantifying stress was the measurement of palmar sweat by means of an evaporimeter. Other measurements used were a bi-polar visual analogue scale and the Spielberger State Anxiety Questionnaire. The results of the study demonstrated a highly significant reduction in the palmar sweat production (P less than 0.0001) and score obtained for the analogue scale (P less than 0.05) following open surgery, but no changes before and after treatment in any of the variables in patients undergoing percutaneous nephrolithotomy or lithotripsy. Analysis of the data in relation to the surgery demonstrated a significantly higher preoperative analogue score in patients undergoing open surgery compared with lithotripsy (P less than 0.05). Post-operatively, patients undergoing lithotripsy had a significantly higher palmar sweat response compared with patients undergoing open surgery (P less than 0.01). Pre-operatively, fear of a general anaesthetic was identified as a factor contributing to anxiety and post-operatively, pain was the most commonly identified stressor. The implications of these results to the patient and to both nursing and medical staff in terms of practice are discussed. This must include a careful pre-operative explanation.