Laser access and utilization preferences for pediatric ureteroscopy: A survey of the Societies of Pediatric Urology.

Abstract

We sought to evaluate laser access and practice variability for pediatric ureteroscopy (URS) across the Societies of Pediatric Urology (SPU) to identify opportunities and barriers for future technology promulgation and evidence dissemination. A 25-question survey was sent electronically to members of the SPU. The questionnaire assessed surgeon and hospital characteristics, treatment preferences based on an index case, and information about available laser units. Descriptive and comparative statistical analyses were performed to assess patterns of care and laser accessibility across the SPU. A total of 105 of 711 (15%) recipients responded. Seventy-seven respondents (73%) reported laser ownership, which was associated with greater after-hours laser access (87% vs. 13%, p<0.01). Fifty-eight individuals provided additional laser specifications, of whom 21 (36%) used a high-powered laser unit (>60 W). Standard-power lasers were used more frequently in free-standing children's hospitals, as compared to those working within a larger hospital complex (75% vs. 50%, p=0.049). Variation existed in treatment preferences with respect to dusting (33, 34%), fragmentation (18, 19%), or a hybrid approach (46 respondents, 48%). Stone clearance was the most important consideration irrespective of treatment choice. Variability in surgical preferences and accessibility to laser units exist across pediatric urologists who perform URS. Laser ownership and access to newer technologies vary across practices and may influence treatment options. Understanding access to laser technology will be important when considering opportunities for surgical optimization to improve patient outcomes through future studies.