Abstract
ABSTRACTObjective:To elucidate the current scenario of endourology in Brazil for the treatment of urinary lithiasis, with an emphasis on regional differences and the reasons why certain techniques are still underutilized.Materials and Methods:An electronic questionnaire was sent by email to the 4,745 members of the Brazilian Urological Society (BSU) in 2016 to collect information on the 3 main endourological procedures used in the treatment of nephrolithiasis: Semi-rigid ureteroscopy (URS), Flexible ureteroscopy (F-URS) and percutaneous nephrolithotripsy (PCNL).Results:A total of 1,267 urologists answered the questionnaire. It was observed that the vast majority perform URS (95.6%), while 80.2% perform F-URS and only 72.1% perform PCNL. Regarding the surgical volume, most perform up to 10 procedures per month (73.4% to 88.2%) and the main impediment was the lack of patients with the pathology (42.1% to 67.7%). The lack of equipment or hospital infrastructure was one of the main limiting factors for rigid (23%) and flexible (38.1%) URS, mainly in the North and Northeast regions of the country. Regarding PCNL, most of them reported lack of practical experience in the method (29.9%). Finally, most urologists expressed interest in taking courses in endourology.Conclusion:Ureteroscopy, rigid or flexible, is already well established in the country, requiring the direction of more resources for its practice, especially in less developed regions. Regarding PCNL a significant part of Brazilian urologists still lack practical experience in this procedure, emphasizing the need for greater investment in teaching this technique.
Highlights
Nephrolithiasis is one of the most frequent urological diseases, with a significant burden on public health system and on patient’s quality of life
General data of urology in brazil In 2018, 5.328 urologists were practicing in Brazil, 97.8% male and 2.2% female, with a median age of 48.7 years, representing 1.4% of the total of Brazilian medical doctors
80 medical residency programs in urology (MRU) were accredited by BSU (65.6%) and in South and Center-West it was observed a higher proportion of accreditation according to total number (80% and 70%, respectively)
Summary
Nephrolithiasis is one of the most frequent urological diseases, with a significant burden on public health system and on patient’s quality of life. The development of digital endoscopes and improvements of Holmium:Yag lasers and hydrophilic and flexible devices mande endourological procedures safer and more efficient, reducing surgical morbidity while improving clinical results [10, 11]. In line with this world tendency, in the last 15 years, the number of endoscopic procedures increased greatly in Brazil, probably due to better training of young urologists during residency and to a higher availability of endoscopic equipment in different health centers [12]
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