Presentation Authors: Gopal Narang*, Durham, NC, Elizabeth Stephenson, Catherine Wiener, Gary Koch, Davis Viprakasit, Chapel HIll, NC
Introduction: Urolithiasis is multifactorial in its etiologies and multifaceted in its treatments. A pillar of effective treatment has been the use of preventative strategies and counseling. Dietary recommendations, fluid intake goals, and medication supplementation are keys to prevention and are widely accepted across multiple urologic guidelines. Preventive counseling, though vital to reducing stone recurrence, is ultimately limited by patient recall and implementation. We looked to evaluate the effectiveness of preventative strategy counseling in recurrent stone formers.
Methods: Established recurrent stone patients were retrospectively analyzed over a 14-month period. Patients routinely received both verbal and written information regarding their individualized stone history and preventive recommendations. At subsequent visits, patients were queried on their stone history and practiced preventative strategies. Patient recall was compared with provider recommendations and prior stone history obtained from the medical record. The relationship between correct recall of stone history and preventative strategies was evaluated using appropriate statistical measures.
Results: The cohort was comprised of 294 patients with 57% male and a mean age of 56 years. Prior stone passage was reported in 62% and 85% required surgical intervention. Stone composition was documented in 207 patients with 85% forming calcium stones. Of those with known stone composition, 39% correctly recalled their stone type. 24-hour urine studies were completed by 126 patients, with an average of 37% of urine metabolic abnormalities correctly recalled. Patients were recommended 4.4 +/- 1.3 preventative strategies each and correctly recalled 44% of recommendations. Correct recall of stone composition and/or metabolic abnormality was associated with an increased likelihood of correctly recalling preventative strategies (p < 0.001).
Conclusions: Patients correctly recalling their stone composition and/or urine metabolic abnormalities are more likely to remember recommended preventative strategies. A greater understanding of one's stone composition history and disease process may provide a stronger context for preventative strategy counseling. Despite a multifaceted counseling approach, less than half of recommended preventative strategies were recalled. The continued use of novel educational techniques and innovative patient outreach programs is necessary for effective stone prevention. Further study is required to determine factors to enhance patient recall and effectiveness of counseling.