Shifting Paradigms in Stone Disease: How Geography, Training, and Technology Shape Endourologic Practice Worldwide

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Endourology offers advanced minimally invasive treatments for urolithiasis.
• Global adherence to established urolithiasis treatment guidelines is inconsistent.
• International practice variations in urolithiasis management require evaluation.

Purpose of the Study:

• To assess international endourological practice patterns for urolithiasis.
• To identify factors influencing treatment decisions in kidney stone management.
• To evaluate adherence to established guidelines in a global context.

Main Methods:

• A 37-question online survey was distributed to Endourology Society members.
• Data included demographics, clinical scenarios, technical preferences, and complex cases.
• Analysis involved descriptive statistics and subgroup comparisons (geography, fellowship, years in practice).

Main Results:

• Retrograde intrarenal surgery (RIRS) is preferred for 6-15 mm stones; percutaneous nephrolithotomy (PCNL) dominates for larger stones (>15 mm) and staghorn calculi.
• Significant practice variations exist based on geography (US vs. international), fellowship training, and surgeon experience.
• Surgeons with less experience favor RIRS, while more experienced surgeons traditionally use PCNL, though RIRS use is increasing across experience levels.

Conclusions:

• Substantial international heterogeneity exists in kidney stone management.
• Percutaneous nephrolithotomy (PCNL) remains key for complex stones, but minimally invasive RIRS is gaining traction.
• Adaptable, evidence-based guidelines are crucial for standardizing global urolithiasis treatment.