Renal colic and urolithiasis practice patterns in Canada: a survey of Canadian Urological Association members

Abstract

Background: We describe the practice variability of CUA (CanadianUrological Association) members and factors which predict thesepatterns for common stone scenarios.Methods: We asked 308 English- and 52 French-speaking CUAmembers to complete online surveys in their respective languages.We collected demographic information on fellowship training,shock wave lithotripsy (SWL) access, academic setting andwhether they are at a hospital with regionalized surgical services.Respondents indicated their actual as well as ideal treatment forscenarios of renal, proximal and distal ureteric calculi.Results: In total, 131 urologists responded (36% response rate), allof whom treated urolithiasis. Of this number, 17% had endourologyfellowship training, 76% had access to SWL, 42% were at anacademic institution and 66% were at institutions with regionalizedsurgical services. Actual and ideal treatment modalitiesselected for symptomatic, distal and proximal ureteric stones (4,8, 14 mm) were consistent with published guidelines. There werediscrepancies between the use of ureteroscopy and SWL in actualversus ideal scenarios. Actual and ideal practices were congruentfor proximal ureteric stones and asymptomatic renal calculi.In multivariate analysis, respondents were less likely to performureteroscopy on proximal 4- and 8-mm stones if they were at ahospital with regionalized surgical services (OR: 0.097; 95% CI:0.01-0.76, p = 0.03 and OR: 0.330; 95% CI: 0.13-0.83, p = 0.02).Interpretation: There is clinical variability in the managementof urolithiasis in Canada; however, management approaches fallwithin published guidelines. Type of hospital and access to operatingroom resources may affect treatment modality selection.