We describe the practice variability of CUA (Canadian Urological Association) members and factors which predict these patterns for common stone scenarios.
We asked 308 English- and 52 French-speaking CUA members to complete online surveys in their respective languages. We collected demographic information on fellowship training, shock wave lithotripsy (SWL) access, academic setting and whether they are at a hospital with regionalized surgical services. Respondents indicated their actual as well as ideal treatment for scenarios of renal, proximal and distal ureteric calculi.
In total, 131 urologists responded (36% response rate), all of whom treated urolithiasis. Of this number, 17% had endourology fellowship training, 76% had access to SWL, 42% were at an academic institution and 66% were at institutions with regionalized surgical services. Actual and ideal treatment modalities selected for symptomatic, distal and proximal ureteric stones (4, 8, 14 mm) were consistent with published guidelines. There were discrepancies between the use of ureteroscopy and SWL in actual versus ideal scenarios. Actual and ideal practices were congruent for proximal ureteric stones and asymptomatic renal calculi. In multivariate analysis, respondents were less likely to perform ureteroscopy on proximal 4- and 8-mm stones if they were at a hospital 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).
There is clinical variability in the management of urolithiasis in Canada; however, management approaches fall within published guidelines. Type of hospital and access to operating room resources may affect treatment modality selection.
Can Urol Assoc J. 2011 Oct;5(5):324-7. doi: 10.5489/cuaj.10193
Canadian report of routines for management of patients with renal colic. The results showed for instance that for distal ureteral stones with a size of 4 mm, conservative treatment was applied in 93% and for stones with a diameter of 14 mm URS was chosen in 80%. Only 6% of the latter patients were referred to ESWL.
Eighty two percent of patients with 4 mm large proximal ureteral stones were treated conservatively, while those with 14 mm stones were managed with URS in 39% and with ESWL in only 37%.
Stones in the kidney were preferentially treated with PNL if they were large, but ESWL was used for stones in the size range 8-14 mm.
There is nothing new to learn or extract from this article. The urologists apparently acted in accordance with local clinical traditions and guidelines.