Treatment of Patients With Small Renal Masses: A Survey of the American Urological Association

Abstract

We surveyed American Urological Association members to determine factors that influence the treatment of patients with small renal masses. In June 2009 American Urological Association members were solicited to complete an online survey. Respondents were asked their preferred treatment for 8 cases and 3 index patients. In each case computerized tomographic axial and schematic coronal images were provided. A total of 759 active urologists with varied training backgrounds and clinical practice settings completed the survey. Tumor size (OR 8.4, 95% CI 7.1-10.1), tumor depth (OR 19.2, 95% CI 14.8-25.0) and tumor location (OR 24.0, 95% CI 18.1-31.8) were markedly associated with preference for radical nephrectomy instead of partial nephrectomy. Fellowship trained urologists (OR 0.4, 95% CI 0.2-0.6) and urologists at academic hospitals (OR 0.6, 95% CI 0.4-0.9) were less likely to choose radical nephrectomy. Respondents were more likely to choose active surveillance in an older patient (OR 2.7, 95% CI 2.1-3.6) or in a patient with comorbidities (OR 10.0, 95% CI 8.0-12.4). Urologists were less likely to choose active surveillance for a 4 vs 2 cm tumor (OR 0.18, 95% CI 0.15-0.21). Active surveillance was chosen more often if the tumor was perihilar vs mid kidney (OR 2.0, 95% CI 1.8-2.3) or polar (OR 2.1, 95% CI 1.9-2.5). There is considerable heterogeneity in the treatment of patients with clinical T1a tumors. Several factors explain these differences as selected treatments are independently associated with tumor, patient and urologist factors.