UNC Med Student Joins UNC Urology Physicians in Kidney Stone Research

Nicholas Koch (UNC School of Medicine Class of 2021)

For patients suffering from kidney stones, pain is the most predominant and consistent symptom.

For more severe cases, where a stone obstructs the urinary tract or there is a sizeable stone burden, surgical intervention is often the only way forward. For any surgical treatment, being able to quantify the results post-operatively is important not only to patients but physicians and researchers as well.

For kidney stones, surgical outcomes and success metrics are often based on the complete relief of the stone burden, and historically physician-determined. However, this method neglects how patients view the outcomes of their stone surgery in relief of their symptoms.

This is where Mr. Nicholas Koch, a medical student at the UNC School of Medicine (Class of 2021) became involved. Completed as part of the Carolina Medical Student Research Program (CMSRP) Mr. Koch sought to implement a modified version of a validated tool called the Patient-Centered Outcomes Questionnaire (PCOQ) to investigate patient perspectives on the outcomes of stone surgery for the relief of their pain symptoms.

In conjunction with UNC Urology practitioners Ms. Leslie Donnelly Lorbacher, AGNP, MSN, RN and Dr. Davis Viprakasit, MD, FACS, Mr. Koch surveyed 50 patients at the UNC Medical Center Urology Clinic between 5/2017 and 7/2018. Patients were asked both pre- and post-operatively to quantify their pain and prioritize criteria for a successful surgery while noting if these priorities/criteria changed post-operatively.

Working with the UNC Department of Biostatistics, Mr. Koch’s project further elucidated that those patients with more pain-focused goals pre-operatively (likely because they were subjectively experiencing higher levels of pain) were significantly less likely to achieve their expected outcomes criteria than those patients with non-pain related outcomes criteria. Moreover, pain-focused patients reported significantly lower desired and expected post-surgery levels when compared to non-pain-focused patients.

Based on these results, Mr. Koch believes that future application of his project to increase the cohort size could be warranted. He also notes that similar applications of his project to patients undergoing chronic pain management for kidney stones in light of the current opioid epidemic exist and could prove vital to understanding the full scope of kidney stone treatment outcomes.

The culmination of Mr. Koch’s research project came on October 29, 2018, where he participated in UNC’s 51st annual Student Research Day and was inducted into the John B. Graham Medical Student Research Society, which was established in 1987 to recognize and promote the research efforts of the student body.