Urolithiasis is a highly prevalent and multifactorial disease, representing the most common urological condition globally. Its incidence continues to rise, posing a significant public health challenge. Management strategies are tailored to individual patients, considering factors such as stone size, composition, location, and underlying metabolic conditions. This review provides a comprehensive overview of both pharmacological and surgical approaches to urolithiasis, emphasising recent advancements and emerging technologies. Surgical treatments, particularly minimally invasive procedures, have shown considerable improvement, offering highly effective solutions with reduced morbidity. While surgical interventions are essential, pharmacological therapies play a key role in preventing recurrence and addressing metabolic abnormalities that contribute to stone formation. Advances in understanding the molecular mechanisms and pathophysiology of urolithiasis are crucial for developing targeted therapies. A holistic approach that integrates advanced surgical techniques with pharmacological interventions, tailored to individual metabolic profiles, is essential for optimising patient outcomes. Personalised management, supported by regular monitoring of urinary pH, metabolic profiles, and adherence to treatment regimens, is vital to reducing recurrence and improving the quality of life for patients with urolithiasis.
Hypothesis / aims of study In recent decades, the use of urinary catheters in the Netherlands has increased substantially, and with the aging population, it is expected that this trend will continue to rise.(1, 2) To improve the standard of care and patient satisfaction, it is important to know more about the catheter users in the Netherlands and their perspective on urinary catheters. The objective of this study was to identify the patient satisfaction and the quality of life (QoL) in long-term (>6 months) urinary catheter users in the Netherlands. Study design, materials and methods A nationwide survey study was conducted from August to September 2024. Patients who apply clean intermittent catheterization (CIC), have an urethral indwelling catheter (IDC), or a suprapubic catheter (SPC), were identified through the MediReva database, a Dutch medical supplier. The survey was developed during a structured consensus meeting by the research team and consisted of the ICIq-LTCqol, the EQ-5D-5L, and a self-made questionnaire about catheter-related complications. Results 3320 patients participated in the study (response rate 33%). 2634 performed CIC, 383 had an IDC, and 303 had an SPC. 75.9% was male and the mean age was 72 years. CIC patients reported the highest patient satisfaction and QoL scores. Thereby they reported the lowest incidence of hematuria and bladder stones, there was no difference in UTI incidence in the last 6 months between the groups. When corrected for multiple confounders IDC and SPC were independently associated with lower patient satisfaction and QoL scores. Interpretation of results This study shows differences in patient satisfaction, QoL and, catheter-related complications between three types of catheterization. IDC and SPC are related with lower patients satisfaction, lower (perceived) QoL and higher catheter-related complications. Therefore, CIC is strongly preferred over IDC and SPC, if the patient is able to perform CIC. Concluding message Healthcare providers should be aware of the impact of bladder drainage methods on the patient satisfaction and QoL, especially for those using an IDC or SPC. This information can be of added value in the decision-making process of long-term bladder management.Figure 1Multivariate regression of the different patient satisfaction and quality of life scores.Funding ZonMW Clinical Trial No Subjects Human Ethics Committee METC Erasmus MC Helsinki Yes Informed Consent Yes
