JMIR Publications

ABSTRACT

Background:

Urinary calculi, affecting 1-13% globally, pose a significant health burden due to high recurrence rates (up to 50% within 10 years) and substantial healthcare costs. Adequate fluid intake is a cornerstone of prevention, yet its adherence remains poor due to forgetfulness, lifestyle barriers, and limited patient education. Existing mobile health (mHealth) interventions for urinary calculi prevention often lack medical oversight and clinical validation. WeChat-based digital therapeutic intervention may have a positive effect on fluid adherence in this patient group.

Objective:

Our objective is to develop a WeChat applet to improve hydration behavior and reduce stone recurrence among postoperative patients with urinary calculi.

Methods:

This is an open-label, two-arm, parallel-group randomized controlled trial. We will recruit 148 participants from China’s tertiary hospital and randomly allocate them in a ratio of 1:1 to the intervention/control group. The intervention group received standard postoperative care supplemented by the WeChat-based Applet Fluid Intake Reminder (WAFIR), which delivers personalized fluid intake reminders, urine color monitoring, 24-hour fluid intake and urine output tracking, and evidence-based educational content on hydration and urolithiasis management. The control group receives standard care of general discharge instructions from nurses. The primary outcome is the fluid adherence, measured by 24-hour fluid intake and urine volume; secondary outcome measures are the Wisconsin Stone Quality of Life Questionnaire (WSQOL), Patient Health Questionnaire-9 (PHQ-9), eHealth Literacy Scale (eHEALS), physical activity (IPAQ-SF), and recurrence rate of urinary calculi. Outcomes are measured before intervention (T0) and after a one-month (T1) and three-month (T2) follow-up period. Intention-to-treat analysis, t-tests, and repeated measures ANOVA will be used to compare outcomes; statistical significance is set at a p < 0.05 significance threshold. The study was approved by the ethics review board in December 2024.

Results:

The development of WAFIR, conducted in collaboration with stakeholders, was finalized in February 2025. Recruitment commenced on March 1, 2025; data collection and analysis are expected to be completed approximately eight months after study commencement. Dissemination of findings is planned through conferences and publications in 2026.

Conclusions:

This research evaluates the effectiveness of a nurse-led, evidence-based digital therapeutic intervention, WAFIR, in overcoming fluid adherence barriers among postoperative patients following urolithiasis surgery, aiming to increase daily fluid intake and urine output, reduce recurrence rates, enhance quality of life, and generate empirical evidence for its application in urology care, thereby optimizing postoperative management within clinical settings.  Clinical Trial: ClinicalTrials.gov: NCT06990672 Registered 24 May 2025—retrospectively registered.