SWL literature
SWL Literature

Önal B. et al., 2021: Different approaches among physicians to treat pediatric stone disease: a survey-based study

Önal B, Kırlı EA, Canpolat N, Taşdemir M, Gürbüz A, Özman O, Sever L, Bilge I, Çalışkan S.
Department of Urology, Cerrahpaşa School of Medicine, Istanbul University- Cerrahpaşa, Istanbul, Turkey. 
Department of Urology, Cerrahpaşa School of Medicine, Istanbul University- Cerrahpaşa, Istanbul, Turkey.
Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
Division of Pediatric Nephrology, Department Pediatrics, Koç University Hospital, Istanbul, Turkey.
Division of Pediatric Nephrology, Department Pediatrics, Koç University School Medicine, Istanbul, Turkey.

Abstract

Introduction: Pediatricians, surgeons and subspecialties as pediatric urology and nephrology are involved in the diagnosis and treatment of pediatric renal stone disease (RSD). The aim of this study was to determine diagnostic and treatment approaches, of different disciplines, and to assess differences in their routine diagnostic and treatment protocols.

Population and methods: A questionnaire was designed and administered to the participants of the RSD sessions in national congresses of all disciplines in 2017 to evaluate the diagnostic and treatment routines of specialties (surgeons and pediatricians) and subspecialties (pediatric nephrologists and pediatric urologists) for RSD.

Results: A total, of 324 questionnaires were analyzed, from 88 pediatricians (27 %), 121 urologists (37 %), 23 pediatric surgeons (7 %), 54 pediatric nephrologists (17 %), and 38 pediatric urologists (12 %). Both groups agreed on the necessity of metabolic evaluation. For distal ureter stones that were ≥ 6 mm; surgeons preferred ureteroscopy (URS), pediatricians preferred shock wave lithotripsy (SWL) (p < 0.001) and subspecialties preferred URS for the treatment (p = 0.636). For lower calix stones less than 1 cm surgeons and subspecialists preferred SWL, while pediatricians preferred hydration (p < 0.001, p = 0.371). For the stone between 1.1 and 2 cm, surgeons preferred intrarenal surgery (RIRS) and SWL, pediatricians preferred SWL (p = 0.001). For larger stones, surgeons and subspecialists preferred percutaneous nephrolithotomy (PCNL), and pediatricians preferred SWL (p = 0.458 p = 0.001). Pediatric urologist chose low-dose computerized tomography as a diagnostic radiologic evaluation (p = 0.029).

Conclusion: There are differences between the disciplines who take an active role in diagnosis and treatment of RSD.

Arch Argent Pediatr. 2021 Apr;119(2):83-90. doi: 10.5546/aap.2021.eng.83. PMID: 33749193 English, Spanish.

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Kommentare 1

Peter Alken am Freitag, 30. Juli 2021 08:30

This is no surprise. Even in the same disciplines similar differences in procedures are found when the therapy choice for the same diagnosis in different hospitals in the same country is analysed (1).
~ 80 % of the responders had 6-10 years of experience and ~ 50 % had > 11-15 years of experience, showing that once an attitude is chosen, it is not or only slowly changed (2) even if the world keeps turning.

1 Wang HH, et al. Shock wave lithotripsy vs ureteroscopy: variation in surgical management of kidney stones at freestanding children's hospitals. J Urol. 2012 Apr;187(4):1402-7. doi: 10.1016/j.juro.2011.12.010.

2 Scales CD Jr, et al.; Urologic Diseases in America Project. Practice variation in the surgical management of urinary lithiasis. J Urol. 2011 Jul;186(1):146-50. doi: 10.1016/j.juro.2011.03.018.
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Peter Alken

This is no surprise. Even in the same disciplines similar differences in procedures are found when the therapy choice for the same diagnosis in different hospitals in the same country is analysed (1). ~ 80 % of the responders had 6-10 years of experience and ~ 50 % had > 11-15 years of experience, showing that once an attitude is chosen, it is not or only slowly changed (2) even if the world keeps turning. 1 Wang HH, et al. Shock wave lithotripsy vs ureteroscopy: variation in surgical management of kidney stones at freestanding children's hospitals. J Urol. 2012 Apr;187(4):1402-7. doi: 10.1016/j.juro.2011.12.010. 2 Scales CD Jr, et al.; Urologic Diseases in America Project. Practice variation in the surgical management of urinary lithiasis. J Urol. 2011 Jul;186(1):146-50. doi: 10.1016/j.juro.2011.03.018. FREE ARTICLE Peter Alken
Gäste
Freitag, 17. September 2021

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