How physician and patient perceptions differ regarding medical management of stone disease.

Abstract

We compared patient and urologist perceptions regarding the medical management of stone disease. A total of 159 patients were prospectively interviewed. Patients were asked 3 questions concerning subjective tolerance of stone passage and surgical intervention weighed against the use of daily preventive medication. The same questions were sent to members of the Endourological Society. Mean +/- SD patient age was 51 +/- 14 years. Recurrent stone formers comprised 72% of patients and 76% had undergone a prior surgical procedure while 43% were taking prophylactic medication. Overall 81% and 88% of patients responded that they would rather take medication than tolerate a single stone event at home or in the emergency room, respectively. Likewise 92% of patients stated that they would prefer daily medication compared to any surgical procedure. Among 61 urologists 26%, 38% and 18% responded that patients would likely tolerate 1, 2 or an unlimited number of stone passages at home, respectively, before agreeing to take medication. Of the urologists 66% estimated that patients would tolerate up to 2 acute stone events requiring an emergency room visit before starting medication. In addition 20%, 31% and 33% of urologists presumed that patients would accept the need for surgery annually, every other year or every third year rather than take medication. Most patients with stones will consider preventive medical therapy to avoid recurrent pain or a surgical procedure. In contrast, most urologists perceive that patients prefer to avoid medication even if it means tolerating several acute stone events and/or surgical procedures.