Current Practice Patterns in the Management of Upper Urinary Tract Calculi in the North Central United States

Abstract

To determine the current practice patterns in the management of upper urinary tract calculi in a large group of urologists in the north central United States. An email survey was sent to 790 practicing members of the North Central Section of the American Urological Association. The survey consisted of questions pertaining to practice and training background, and case scenarios with treatment options for upper urinary tract calculi of different sizes at various locations. The responses were then statistically analyzed to determine practice trends. Seven urologists did not fill out the survey, as they did not manage patients with stone disease. The overall response rate was 23% (167/783). Although more than 75% of urologists were trained to perform extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) during their residency, only 61% and 17% were trained to perform open stone surgery (OSS) and medical expulsive therapy (MET), respectively. Twelve percent of respondents were fellowship trained in endourology. Observation was most commonly recommended for asymptomatic renal calculi <5 mm in size (92%). Although SWL continues to be the most commonly utilized therapy for renal (43%-92%) and proximal ureteral calculi <20 mm in size (29%-51%), and PCNL for renal calculi >20 mm in size (72%-92%), many urologists (48%) favored PCNL for lower pole calculi 10 to 20 mm in size. Use of URS was mostly favored for distal (44%-90%) and proximal ureteral calculi (23%-46%), while MET was recommended for small ureteral calculi <5 mm in size (25%-32%). Fellowship-trained endourologists, academic urologists, and urologists in practice for less than 5 years were more likely to utilize URS, PCNL, and MET, and less likely to utilize SWL for urinary calculi. The results of this survey suggest that practice patterns for treatment of stone disease match the treatment approach recommended in the published literature. This information can be further utilized for assessment of guidelines for the treatment of stone disease.