Imagine you have an 8 mm stone in your kidney. It is currently not causing any symptoms or risk of infection. Please select which of the following options you would choose, regardless of potential costs involved:

  1. Observation

-would follow your stone annually with an x-ray to see if it grows

-it is very unlikely that the stone will cause any problem with kidney function

-30% chance that the stone will not grow or cause pain or need a surgery over 4 years

-Risks:

  • Stone growth – odds of this are 40% over 4 years
  • if it gets larger than 10mm then shockwave lithotripsy will no longer be an option
  • Moves into the ureter – odds of this is 30% over 4 years
  • If it moves into the ureter – chance of passage 25%
  • If it moves half-way down and gets stuck – shockwave lithotripsy will no longer be an option
  1. Shockwave lithotripsy

-out-patient surgery, non-invasive (no scopes or stents)

-takes one hourunder conscious sedation (in a “twilight state”, still awake during procedure, but given medication to relax and relieve pain)

-minimal pain, back to work in 2 days on average

-no heavy lifting or vigorous exercise for 2 weeks

-typically fragments are about the size of a grain of sand and pass easily

-Success: 65%

-Risks:

  • 1 in 1000 risk of a serious bleed requiring transfusion
  • 1 in 100 risk of needing an emergent second procedure if a larger stone fragment gets stuck
  1. Ureteroscopy

-out-patient surgery, minimally invasive

-scope goes into your bladder, up the ureter and laser breaks up the stone

-takes one hour, general anesthesia

-you need a stent for one week – 80% of patients will have some discomfort

  • pain in bladder and/or pain in kidney
  • 1 in 10 will be significant discomfort

-No restrictions on activity other than any limitations due to stent discomfort

-Stent comes out in clinic (short 5 min procedure where a scope is placed in your bladder)

-Success: 90%

-Risks:

  • 1 in 1000 risk of a serious injury to the ureter – would require major surgery to repair
  • 1 in 100 risk of a minor injury requiring a stent for 2-3 weeks
  • Small risk of a urinary tract infection

SUMMARY

1. Observation / 2. Shockwave / 3. Ureteroscopy
Success / 25% passage / 65% / 90%
Anesthesia / None / Sedation / General
Stent / No / No / Yes
Main risks / Pain (30%)
Stone growth (40%)
Need for surgery (25%) / Serious bleed - (1 in 1000)
Need for ureteroscopy - (1/100) / Serious injury
(1 in 1000)
Minor injury
(1 in 100)

Age:______

Gender: Mor F

I chose:

  1. Observation
  1. Shockwave lithotripsy
  1. Ureteroscopy

In the above scenario, would youprefer to:

  1. follow the doctors recommended treatment
  2. Make your own treatment decision based on the written information provided.

What variable was most important to you in your decision?

  1. Success rate
  2. Risk of complication
  3. Anticipated post-operative pain
  4. Other: ______

Have you passed a stone before? Yes or No

If yes, how many stones have you passed?______

When was the last stone you passed (days/months/years):______

How big was the largest stone you passed (mm): ______

What has been the worst kidney stone pain you have had? 1 2 3 4 5 6 7 8 9 10

More pain 

Have you had any of the following procedures (circle all that apply):

  1. Ureteral stent: Total # ______
  2. Shockwave lithotripsy: Total # ______
  3. Ureteroscopy: Total # ______
  4. Percutaneous Nephrolithotomy (PCNL or PUP): Total # ______

Any comments?