Despite kidney stone disease (KSD) guidelines, high-quality evidence for KSD management in Canada is lacking. We aimed to assess Canadian urologists' practice patterns, preferences, and barriers in managing KSD.
A cross-sectional survey was distributed to Canadian urologists via the Canadian Urological Association (CUA), Quebec Urological Association (QUA), and Canadian Endourology Group (CEG), as well as directly to urology departments nationwide. Descriptive statistics were used to analyze the results.
Of 93 respondents, 47% were from academic centers, 43% from community hospitals, and 10% from mixed/private settings. Most performed over 75 ureteroscopies and fewer than 25 percutaneous nephrolithotomies (PCNLs) annually (67% and 58%, respectively). Holmium:YAG (Ho:YAG) lasers were available in 85% of hospitals, thulium fiber laser (TFL) in 70%, and Ho:YAG with Moses effect lasers in 28%. Preferred surgical devices included the TFL (74.5%), followed by the Ho:YAG laser (24.2%) and Ho:YAG with Moses effect laser (21.7%). Endourology fellowship-trained urologists (53%) were more likely to perform their own PCNL access (90% vs. 23%, p<0.001), metabolic workup (73% vs. 48%, p=0.02), and felt more comfortable prescribing prophylactic and medical treatment for KSD (86% vs. 50%, p<0.01) compared to non-endourology fellowship-trained colleagues. Metabolic workup was delegated to nephrologists or specialized clinics by 38%, mainly due to lack of time (25%) and expertise (25%). Additionally, 71% lacked access to multidisciplinary KSD clinics, with 76% believing such clinics would be beneficial.
The study highlights variability in KSD management practices and barriers. Addressing these issues could improve KSD care in Canada and inform future guidelines.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2024 Dec 09 [Epub ahead of print]
Anis Assad, Mahmoud Moustafa, Brendan L Raizenne, Michael Kogon, Jason Y Lee, Michael Ordon, Sero Andonian, Andrea Lantz Powers, Jennifer Bjazevic, Shubha De, Ben H Chew, Naeem Bhojani
Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada., Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada., Division of Urology, Mackenzie Health, Vaughan, ON, Canada., Division of Urology, University of Toronto, Toronto, ON, Canada., Division of Urology, McGill University, Montreal, QC, Canada., Department of Urology, Dalhousie University, Halifax, NS, Canada., Department of Urology, Schulich School of Medicine and Dentistry, London, ON, Canada., Division of Urology, University of Alberta, Edmonton, AB, Canada., Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.