Decision-Making, Preference, and Treatment Choice for Asymptomatic Renal Stones—Balancing Benefit and Risk of Observation and Surgical Intervention: A Real-World Survey Using Social Media Platform

Abstract

Introduction: The burden of kidney stone disease (KSD) has risen, and several treatment options now exist. We wanted to evaluate the preference and treatment choices based on the information provided for management of hypothetical 8mm and 15mm renal stone, and factors that influenced their decision. Methods: An online questionnaire to investigate trends in decision-making for two hypothesized scenarios of asymptomatic kidney stones (8mm and 15mm) was formatted online in Microsoft Forms and posted on social media (Facebook) in Europe. The ethical approval was obtained from the university ethics committee and data was collected from general public between Sept-Nov 2020. Results: A total of 476 participants of different age and background answered the survey with a male:female ratio of 1:2.7. The age groups were categorised as 18-25 years (n=149), 26-49 years (n=192) and 50+ years (n=135). In the 8mm scenario, 107 of the 476 participants (22.5%) chose observation (OBS), 249 (52.3%) chose shockwave lithotripsy (SWL) and 120 (25.2%) opted for ureteroscopy (URS). In the 15mm scenario, 194 participants chose SWL treatment (40.8%), 216 (45.4%) URS, and 66 (13.9%) preferred percutaneous nephrolithotomy (PCNL). The influencing factors were success rate, complication risk and invasiveness of the procedure. On comparison to 8mm stone, while stent avoidance and activity limitation were considered less important with 15mm stone (p<0.001), complication rates were considered more important (p<0.001). Conclusion: More than one treatment choice for kidney stones often exists and clinicians must take patient choice into account via an informed decision-making process. While some might accept a higher risk of invasiveness and complications for higher stone free rate, others might have a more conservative approach to this. It is about time that urologists take patient priorities and concerns into account and perhaps use PROMS in addition to clinical outcomes when comparing treatment success.