Population-level Prevalence, Effect on Quality of Life, and Treatment Behavior for Renal Colic and Urolithiasis in Poland
Conditions: Renal Colic, Urolithiasis
Sponsor: Mikolaj Przydacz

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Official Title of the Study 
Population-level prevalence, effect on quality of life, and treatment behavior for renal colic 
and urolithiasis in Poland 
 
 
Brief Title 
Renal colic and urolithiasis in Poland 
 
NCT Number 
NCT06176469 
 
Unique Protocol Id 
118.6120.94.2023 
 
Date 06/01/2023 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Questionnaire (aligned with the study protocol) 
 
 
R. Demographic parameters: 
 
R1. Please enter your year of birth: 
 
R2. Please indicate your sex: 
1. Man 
2. Woman 
 
R3. Please indicate your place of residence: 
1. City with over 500,000 inhabitants 
2. City with 100,000–500,000 inhabitants 
3. City with 20,000–100,000 inhabitants 
4. City with up to 20,000 inhabitants 
5. Rural area 
 
R4. Please indicate the voivodeship (province) of your residence: 
1. dolnośląskie 
2. kujawsko-pomorskie 
3. lubelskie 
4. lubuskie 
5. łódzkie 
6. małopolskie 
7. mazowieckie 
8. opolskie 
9. podkarpackie 
10. podlaskie 
11. pomorskie 
12. śląskie 
13. świętokrzyskie 
14. warmińsko-mazurskie 
15. wielkopolskie 
16. zachodnio-pomorskie 
 
R5. What is your level of education? 
1. Primary 
2. Vocational 
3. Secondary 
4. High 
 
 

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R6. What is your marital status? 
1. Single 
2. Married 
3. Divorced 
4. Widow/Widower  
 
 
R7. What is your employment status? 
1. Employed 
2. Unemployed 
3. Retired (pensioner) 
4. Homekeeper (housewife/husband) 
 
 
R8. Have you worked or are you currently working in a profession that involves 
exposure to high ambient temperature (e.g., cooker/baker/miner/steelworker)? 
1. Yes 
2. No 
 
 
R9. Do you or did you have free access to drinking water at work? 
 
1. Yes 
2. No 
 
 
R10. Do you or did you have free access to a toilet at work? 
1. Yes 
2. No 
 
 
R11. Please select the profession you currently have or had: 
1. Manual worker 
2. Scholarly or office worker 
3. Never been employed 
 
D1-D9. Renal colic-like pain symptoms: 
 
SCRIPT: If your answer is “no,” proceed to question D10  
D1. Have you ever experienced back pain (in the kidney area) that was cramp-like, 
intermittent, coming and going, and possibly radiating to the groin (commonly referred 
to as "renal colic")? This pain is typically located along the sides of the back and is 
unrelated to movement or changes in body position. The pain may also be 
accompanied by nausea or vomiting. 
1. Yes 
2. No 

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D2. Did you seek help or treatment for these symptoms? 
1. Yes 
2. No 
 
SCRIPT: If your answer is “no,” proceed to question D7  
D3. Did you receive help or treatment for these symptoms? 
1. Yes 
2. No 
 
Multi-answer question  
D4. What type of treatment did you receive? 
1. Over-the-counter medication 
2. Prescribed medication 
3. Surgical treatment 
4. Other 
 
D5. Are you continuing the treatment that was provided for you? 
1. Yes 
2. No 
 
D6. Are you satisfied with the treatment that was provided? 
1. Yes 
2. No 
 
D7. Do these symptoms still occur for you, that is, do they recur from time to time? 
1. Yes 
2. No 
 
D8. Have the symptoms we are asking about occurred for the first time within the past 
year, i.e., in the prior 12 months? 
1. Yes 
2. No 
 
D9. Which of the following statements best describes your feelings regarding the 
occurrence of these symptoms? 
1. The symptoms generally do not cause me any trouble. 
2. The symptoms cause me very little trouble. 
3. The symptoms cause me some trouble. 
4. The symptoms cause me moderate trouble. 
5. The symptoms cause me significant trouble. 
6. The symptoms cause me a great deal of serious trouble. 
 
 
D10-D16. Urolithiasis 
 
SCRIPT: If your answer is “no,” proceed to question D16 

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D10. Have you ever been diagnosed with urinary tract stones/urolithiasis? 
1. Yes 
2. No 
 
Multi-answer question 
D11. Where in the urinary tract was the stone diagnosed? 
1. Kidney 
2. Ureter 
3. Bladder 
4. I don't know 
 
Multi-answer question, answer 4 - deactivates answers 1-3  
D12. How was your urinary tract stone diagnosed? 
1. Ultrasound (USG) 
2. Computed tomography (CT scan) 
3. Abdominal X-ray (RTG) 
4. No additional tests 
 
Multi-answer question, answer 8 - deactivates answers 1-7 
D13. How was your urinary tract stone treated? 
1. Observation (without pharmacological or surgical treatment) 
2. Over-the-counter medication 
3. Prescribed medication 
4. Surgical procedure through the urethra (URS) 
5. Surgical procedure through a puncture in the back (PCNL) 
6. Surgical procedure through an abdominal incision (open or laparoscopic 
surgery) 
7. Stone fragmentation using external shock wave therapy (ESWL) 
8. Not treated 
 
Multi-answer question, answer 5 - deactivates answers 1-4 
D14. Was urinary tract stone prevention suggested to you? 
1. Increased fluid intake 
2. Dietary changes (dietary recommendations) 
3. Over-the-counter medication 
4. Prescribed medication 
5. No prevention applied 
 
D15. Do you experience recurrent urinary tract stones? 
1. Yes 
2. No 
 
 

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D16. Has anyone in your family ever had urinary tract stones? 
1. Yes 
2. No 
 
E. General Health: 
 
E1. Please enter your weight in kilograms (approximately): 
|_|_|_| kg 
 
 
E2. Please enter your height in cm (approximately): 
|_|_|_| cm 
 
Table, singles in row 
E3. Please indicate which of the following diseases you have and what lifestyle 
characteristics describe you: 
 
Column list: 
1. Yes 
2. No 
 
Rows list: 
1. Hypertension 
2. Heart failure 
3. Diabetes 
4. Gout 
5. Liver disease 
6. Intestinal disease (e.g., Crohn's disease, fistulas, malabsorption disorders) 
7. Chronic kidney disease/Chronic renal failure 
8. Hyperparathyroidism 
9. Overweight/obesity 
10. Polycystic kidney disease 
11. Intestinal surgery 
12. Sarcoidosis 
13. Spinal cord injury 
14. Multiple sclerosis 
15. Cancer (any) 
16. Hematological malignancy (e.g., lymphoma, leukemia, myeloma) 
17. Urological malignancy (e.g., prostate cancer, bladder cancer, kidney cancer, ureter 
cancer, urethral cancer, testicular cancer) 
18. Benign prostatic enlargement  
19. Recurrent urinary tract infections 
20. Neurogenic bladder 
21. Other urological diseases 
22. Smoking  
23. Alcohol consumption (2 or more servings per day) 
24. Drinking at least 2.5 liters of fluids per day 

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25. Salting food 
 
Table, singles in row 
E4. How often do you consume: 
 
Column list: 
1. Every day 
2. Every other day 
3. Once a week 
4. Rarely 
5. Never 
 
Rows list: 
1. Beef 
2. Pork 
3. Poultry 
4. Cold cuts, sausages, hot dogs, pâtés, canned food 
5. Dairy products (e.g., milk, yogurt, eggs, kefir, cheese) 
6. Cereal products (products made from rye, oats, wheat, corn, rice) 
7. White bread 
8. Whole grain bread 
9. Legumes (e.g., chickpeas, beans, peas, fava beans) 
10. Soy products 
11. Fresh fruits 
12. Fresh vegetables 
13. Nuts 
14. Cocoa/chocolate 
15. Highly processed sweets (e.g., bars, cookies, pastries) 
16. Spinach 
17. Strawberries 
18. Fruit juices 
19. Sweetened beverages (e.g., soda) 
20. Coffee 
21. Tea 
22. Instant meals/ramen noodles 
23. Fast food dishes 
 
Table  
E5. Are you receiving treatment from a urologist? 
1. Yes 
2. No 
 
 
 

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E6. Are you receiving treatment from an endocrinologist or a diabetologist? 
1. Yes 
2. No 
 
E7. Are you receiving treatment from a cardiologist? 
1. Yes 
2. No 
 
 
E8. Are you receiving treatment from a nephrologist? 
1. Yes 
2. No 
 
E9. Are you receiving treatment from a neurologist? 
1. Yes 
2. No 
 
K. International Prostate Symptom Score (IPSS)  
 
 
L. Overactive Bladder-Validated 8-question Screener (OAB-V8)  
 
 
Z. General quality of life: 
 
Z1. If you had to spend the rest of your life in your current general state, how would you 
describe your well-being? 
1. Excellent 
2. Satisfied 
3. More than half satisfied 
4. Half-satisfied 
5. Less than half dissatisfied 
6. Unhappy 
7. Terrible