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Angulo JC et al, 2017: Trends in the management of urolithiasis in Latin America, Spain and Portugal: results of a survey in the Confederación Americana de Urología (CAU).

Angulo JC, Bernardo N, Zampolli H, Rivero MA, Dávila H, Gutiérrez J.
Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, España.
Departamento de Urología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina.
Departamento de Urologia, Instituto do Cancer Dr. Arnaldo Vieira de Carvalho, São Paulo, Brasil.
Especialista consultor en Urología y Andrología, Buenos Aires, Argentina.
Departamento de Urología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela.
Departamento de Urología, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, Carolina del Norte, EE. UU.

Abstract

OBJECTIVE: To describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognise patterns of clinical practice and identify educational needs.
MATERIAL AND METHOD: An online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions.
RESULTS: A total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (P<.001), and the proportion of users of flexible URS was greater in the Portuguese countries (P=.037). The main energy source was laser (60.7%). Small-calibre PCNL was performed by 15.3% of the respondents, more often in university hospitals (P<.01) and by older practitioners (P<.01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (P<.001). The supine position was used by 40.4% of the respondents, more often in Spain (P<.001) and in the university setting (P=.017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner calibre sheaths (P<.001).
CONCLUSIONS: The management of lithiasis in the CAU setting follows a profile similar to that recognised in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-calibre PCNL and ultrasound-guided puncture.

Actas Urol Esp. 2017 Jun 3. pii: S0210-4806(17)30084-0. doi: 10.1016/j.acuro.2017.03.007. [Epub ahead of print] English, Spanish

 

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Peter Alken on Wednesday, 08 November 2017 08:22

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