SWL literature
Slider

Betschart P. et al., 2019: Spoilt for Choice: A Survey of Current Practices of Surgical Urinary Stone Treatment and Adherence to Evidence-Based Guidelines among Swiss Urologists

Betschart P, Zumstein V, Jichlinski P, Herrmann TRW, Knoll T, Engeler DS, Müllhaupt G, Schmid HP, Abt D.
Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Department of Urology, University Hospital of Lausanne, Lausanne, Switzerland.
Department of Urology, Cantonal Hospital Thurgau, Thurgau, Switzerland.
Department of Urology, Sindelfingen-Böblingen Medical Centre, University of Tübingen, Sindelfingen, Germany.

Abstract

INTRODUCTION: Urologists have to master a variety of techniques to be able to offer the most appropriate surgical stone treatment for each individual patient. Therefore, we performed a survey among board-certified Swiss urologists to assess the availability of the different surgical methods, the current practices of surgical treatment of urolithiasis and the adherence to evidence-based guideline recommendations in Switzerland. METHODS: A 14-question survey assessed the working environment, equipment, perioperative settings and decision trees for specific stone scenarios. Data was analyzed using descriptive statistics and chi-square tests to determine differences between frequencies of answers. RESULTS: Hundred and five members of Swiss Urology (38%) completed the survey. All treatment modalities are available for the majority of respondents. Ureterorenoscopy was found to have the highest availability (100%) and was the preferred choice in the majority of stone scenarios. A high adherence to the guidelines was found for the treatment of ureteral stones <10 mm (100% proximal and distal), and >10 mm (69% proximal, 94% distal). All respondents answered in accordance with the guidelines regarding the treatment of middle and upper pole stones <10 mm, 10-20 mm and lower pole stones 10-20 mm. Guideline adherence was 99% for lower pole stones <10 mm, 78% for lower pole stones >20 mm, and 63% for middle/upper pole stones >20 mm. CONCLUSION: This survey provides a detailed insight into current stone treatment practices in Switzerland. The full spectrum of urinary stone treatment options is available for the majority of Swiss urologists. The choice of treatment shows a high accordance with evidence-based guidelines and a preference for retrograde endoscopic surgery in the majority of stone scenarios.

Urol Int. 2019;103(3):357-363. doi: 10.1159/000502806. Epub 2019 Sep 10. Free PMC Article

0
 

Comments 1

Peter Alken on Friday, 29 November 2019 08:15

SWL is also in retreat in Switzerland. 40% of the participants of this survey had no own SWL device and only 55% of them referred patients to an external hospital for SWL.

Whenever the guideline offered a choice between URS or ESWL to treat stones in the different locations, URS was the primary choice compared to ESWL. Information about costs and reimbursement would be needed, to understand the driving forces behind the treatment choices. Outcome data were not recorded and thus it is not known how patients benefit from the therapeutic shift. Handling of the patients differs a lot from country to country: ESWL is done under general anesthesia in 7%, 26% and 78% in Germany, Switzerland and the US respectively.

The authors have recently published a systematic analysis of available guidelines on the stone treatment: Zumstein V et al. Surgical management of urolithiasis - a systematic analysis of available guidelines. BMC Urol. 2018 Apr 10;18(1):25. doi: 10.1186/s12894-018-0332-9. Free PMC Article

SWL is also in retreat in Switzerland. 40% of the participants of this survey had no own SWL device and only 55% of them referred patients to an external hospital for SWL. Whenever the guideline offered a choice between URS or ESWL to treat stones in the different locations, URS was the primary choice compared to ESWL. Information about costs and reimbursement would be needed, to understand the driving forces behind the treatment choices. Outcome data were not recorded and thus it is not known how patients benefit from the therapeutic shift. Handling of the patients differs a lot from country to country: ESWL is done under general anesthesia in 7%, 26% and 78% in Germany, Switzerland and the US respectively. The authors have recently published a systematic analysis of available guidelines on the stone treatment: Zumstein V et al. Surgical management of urolithiasis - a systematic analysis of available guidelines. BMC Urol. 2018 Apr 10;18(1):25. doi: 10.1186/s12894-018-0332-9. Free PMC Article
Guest
Monday, 09 December 2019
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com