Effect of Comprehensive Spa Care on Kidney and Urological Conditions: A Clinical Study in Adult Patients

This is a single-arm, pretest-posttest study evaluating the effects of a 21-day comprehensive spa care (Komplexní lázeňská léčebně rehabilitační péče, KLP) on patients with nephrological and urological conditions treated at a spa facility in Mariánské Lázně, Czech Republic. The study enrolls 150 adult patients (75 men and 75 women), aged 40-70 years, who are prescribed KLP for indications VIII/1 (recurrent and chronic non-tuberculous inflammation of the kidneys and urinary tract), VIII/2 (nephrolithiasis without urinary tract obstruction, nephrocalcinosis), VIII/3 (conditions after kidney and urinary tract surgery), and VIII/4 (chronic prostatitis or prostatovesiculitis resistant to pharmacological treatment). The spa treatment consists of the use of natural healing resources of Mariánské Lázně, including a mineral spring drinking cure, balneotherapy (mineral water baths), peloid therapy, carbon dioxide therapy, climatotherapy, exercise therapy, and dietotherapy. The standard treatment duration is 21 days, during which each patient receives a total of 63 therapeutic procedures and drinks mineral spring water three times daily. Patients undergo assessments at the beginning (days 1-3) and at the end (days 19-21) of their treatment. Assessments include physical examination, abdominal and urinary tract ultrasound, blood and urine sampling with laboratory analysis, body composition measurement using bioelectrical impedance analysis (InBody), and psychometric questionnaire surveys. The primary aim of the study is to objectively assess the therapeutic effect of comprehensive spa care on nephrological and urological diseases by comparing pre-treatment and post-treatment clinical, laboratory, and patient-reported outcomes. The study was approved by the Ethics Committee of the University Hospital and Faculty of Medicine in Pilsen (decision of November 2, 2023, ref. no. 437/23).

STUDY DESIGN AND SETTING: This is a prospective, single-arm study using a one-group pretest-posttest design conducted at a spa facility in Mariánské Lázně, Czech Republic. The study evaluates the effects of standard comprehensive spa care on patients with nephrological and urological conditions (indication group VIII). The treatment is provided as part of routine clinical care covered by health insurance. The study does not modify the treatment protocol; it collects clinical data before and after the treatment to objectively assess its effects. INTERVENTION: The intervention is a standard 21-day comprehensive spa care program (KLP) prescribed for indication group VIII. The treatment is based on the natural healing resources specific to Mariánské Lázně and includes: drinking cure using local mineral springs (three times daily), mineral water baths, peloid therapy (peat applications), carbon dioxide therapy, climatotherapy, exercise therapy, and dietotherapy with nutritional counseling. Additional procedures may be prescribed by the spa physician based on individual patient assessment. Each patient receives a total of 63 therapeutic procedures during the 21-day stay. ASSESSMENT SCHEDULE: All assessments are performed at two time points: at the beginning of KLP (no later than day 3 after admission) and at the end of KLP (day 20 or 21, exceptionally day 19). Blood samples (5 ml serum in a red-top tube and 3 ml K3EDTA in a purple-top tube) and urine samples (one unpreserved tube) are collected in the morning under fasting conditions at both time points. Laboratory analysis is performed by an external certified laboratory. A total of 300 sample collections are planned (150 at entry, 150 at exit). Physical examinations and ultrasound assessments of the kidneys, urinary bladder, urinary tract, and (in male patients) the prostate are performed at both time points by a urologist. Body composition is measured using bioelectrical impedance analysis (InBody device). Questionnaire-based assessments are administered at both time points. DATA MANAGEMENT: All patient data are pseudonymized using unique ID codes assigned at enrollment. Data are collected in both paper and electronic form. Paper records are stored in individual binders organized by patient ID. Electronic data are transferred to the Institute of Spa Medicine and Balneology (ILaB) on a password-protected, AES-128 encrypted USB drive at regular two-month intervals. Data handling complies with EU General Data Protection Regulation (GDPR, Regulation 2016/679) and Good Clinical Practice principles. ILaB is responsible for the final statistical analysis and interpretation of the collected data. ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee of the University Hospital and Faculty of Medicine in Pilsen. All participants provide written informed consent before enrollment. The study procedures (ultrasound, blood and urine sampling, questionnaires) represent minimal risk and trial.show_full_description

Inclusion Criteria: * Male or female aged 40 to 70 years * Prescribed comprehensive spa care (KLP) for one of the following indications: recurrent and chronic non-tuberculous inflammation of the kidneys and urinary tract resistant to antibiotic and pharmacological treatment, with at least 12 months of continuous urological care (indication VIII/1); cystic kidney disease (indication VIII/1); nephrolithiasis without urinary tract obstruction or nephrocalcinosis (indication VIII/2); conditions after kidney or urinary tract surgery, including endovesical procedures, complicated prostatectomy, nephrolithotripsy, or recovery after extracorporeal shock wave lithotripsy (indication VIII/3); chronic prostatitis or chronic prostatovesiculitis resistant to pharmacological and antibiotic treatment, with at least 12 months of continuous urological care (indication VIII/4) * Able to walk from the sanatorium to the colonnade and back three times daily * Willing to follow the treatment plan * Signed informed consent Exclusion Criteria: * Contraindications according to Czech Decree No. 2/2015 Coll. on spa treatment criteria (pregnancy, acute illness, etc.) * Significant mobility limitation or severe neuropathy preventing daily walks to the colonnade * Significant obesity or inability to briefly hold breath (required for ultrasound examination) * Alcohol intake exceeding 20 g of ethanol per day * Nephrolithiasis with urinary tract obstruction * History of esophageal or gastric variceal bleeding * Severe comorbidities that could affect treatment outcomes * Active oncological disease * Unwillingness to adhere to the treatment plan