Kidney stone disease Practice patterns among urologists in Canada

Area of Science:

• Urology
• Nephrology
• Medical Practice Management

Background:

• High-quality evidence for kidney stone disease (KSD) management in Canada is limited, despite existing guidelines.
• Canadian urologists' current practices, preferences, and perceived barriers in KSD management are not well-documented.

Purpose of the Study:

• To assess the current practice patterns of Canadian urologists in managing kidney stone disease.
• To identify urologists' preferences regarding surgical devices and treatments for KSD.
• To explore the barriers encountered by Canadian urologists in providing comprehensive KSD care.

Main Methods:

• A cross-sectional survey was distributed to urologists across Canada through professional associations and directly to departments.
• Descriptive statistics were employed to analyze the survey data.
• The survey captured information on procedure volumes, technology availability, and perceived challenges.

Main Results:

• Most urologists perform over 75 ureteroscopies and fewer than 25 percutaneous nephrolithotomies (PCNLs) annually.
• Thulium fiber laser (TFL) is the preferred surgical device, with Holmium:YAG (Ho:YAG) lasers also widely available.
• Endourology fellowship-trained urologists demonstrated higher rates of performing PCNL access, metabolic workup, and prescribing medical treatments.
• Barriers to metabolic workup include lack of time and expertise, with 38% delegating this to other specialists.
• A significant majority (71%) lack access to multidisciplinary KSD clinics, though 76% believe they would be beneficial.

Conclusions:

• Canadian urologists exhibit considerable variability in their approaches to kidney stone disease management.
• Key barriers identified include limited access to advanced technology, challenges in performing comprehensive metabolic evaluations, and a lack of integrated multidisciplinary care.
• Addressing these practice variations and barriers is essential for enhancing KSD care and developing evidence-based guidelines in Canada.