de Bayser H, Neuville P, Etienne J, Paparel P, Badet L, Abid N
Service d'urologie et de transplantation, centre hospitalier Édouard-Herriot, Lyon, France.
Service d'urologie, centre hospitalier Lyon Sud, Pierre-Bénite, France.
Prog Urol. 2023 Feb;33(2):88-95. doi: 10.1016/j.purol.2022.12.002. Epub 2022 Dec 28.
Urolithiasis is a common chronic disease whose effect on patients' quality of life (QOL) is considerable but depends on the treatment received, differing between types of surgery. Intrarenal stones can be treated with different techniques: extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (fURS), and mini percutaneous nephrolithotomy (mini-PCNL), with proportional success and complication rates. The aim of this study was to qualitatively explore the impact of the different techniques on patients' QOL and understand their experiences of treatment choices.
Patients treated for medium-sized kidney stones (10-20mm in diameter) were interviewed in a semi-structured manner. The interview data were transcribed and analyzed by theme according to consolidated criteria for reporting qualitative research (COREQ) guidelines.
Data saturation was achieved after interviewing 15 patients. The mean interview time was 34min (standard deviation (SD), 6.8min). The mean patient age was 54 years (SD, 9.5 years). Eight patients underwent ESWL, 10 were treated with fURS, and 8 underwent mini-PCNL. Twenty-seven subthemes were coded and regrouped into eight major themes, namely: no sense of choice in the decision-making process for eleven patients; extremely negative experiences of double-J stents for fourteen patients; concern about the risk of recurrence or treatment failure for thirteen patients; complicated hygiene and dietary recommendations for nine patients; technique-dependent postoperative outcomes; relatively well-tolerated operations for thirteen patients; a poor experience of sick leave, often because of a double-J stent; different views regarding future operations. In fact, a third of patients would choose the most effective treatment, a third would choose the simplest procedure and the last third would trust their urologist. Patients' experiences of these operations are variable.
Urologists must support their patients by presenting the different treatment options with clear, appropriate, and unbiased information. This should ensure patients take part in treatment decisions as part of a personalized treatment plan.
尿石症是一种常见的慢性疾病，对患者生活质量（QOL）有相当大的影响，但这取决于所接受的治疗，不同类型的手术之间存在差异。肾内结石可以采用不同的技术进行治疗：体外冲击波碎石术（ESWL）、软性输尿管镜检查（fURS）和微创经皮肾镜取石术（mini-PCNL），其成功率和并发症发生率各不相同。本研究的目的是定性探讨不同技术对患者生活质量的影响，并了解他们在治疗选择方面的体验。
对接受治疗的直径为10至20毫米的中型肾结石患者进行了半结构式访谈。访谈数据根据定性研究报告综合标准（COREQ）指南进行转录和主题分析。
在采访了15名患者后达到了数据饱和。平均访谈时间为34分钟（标准差（SD），6.8分钟）。患者的平均年龄为54岁（SD，9.5岁）。8名患者接受了ESWL治疗，10名患者接受了fURS治疗，8名患者接受了mini-PCNL治疗。27个次主题被编码并重新归纳为8个主要主题，即：11名患者在决策过程中没有选择感；14名患者对双J支架有极其负面的体验；13名患者担心复发或治疗失败的风险；9名患者面临复杂的卫生和饮食建议；术后结果取决于技术；13名患者对手术的耐受性相对较好；病假体验不佳，通常是因为双J支架；对未来手术有不同看法。事实上，三分之一的患者会选择最有效的治疗方法，三分之一的患者会选择最简单的手术，最后三分之一的患者会信任他们的泌尿科医生。患者对这些手术的体验各不相同。
泌尿科医生必须通过提供清晰、恰当且无偏见的信息来介绍不同的治疗方案，以此来支持他们的患者。这应确保患者作为个性化治疗计划的一部分参与治疗决策。
