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

Abstract

Background: We describe the practice variability of CUA (Canadian
Urological Association) members and factors which predict these
patterns for common stone scenarios.

Methods: 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.

Results: 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).

Interpretation: 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.