Urology Practice Setting Affects Stone Treatment Choice

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Community-based urologists more commonly opt for shock wave lithotripsy (SWL) to treat symptomatic kidney stones than do those in academic practice, according to a study.

The study, which examined the responses of 180 urologists who completed an electronic survey that asked questions related to their treatment of symptomatic stone disease, revealed that high-volume SWL practices (more than 100 cases annually) were significantly more common in community practice, and high-volume ureteroscopy and percutaneous nephrolithotomy practices were significantly more common in academic practice, the researchers reported in Urology (2012;79:996-1003).

In addition, survey results showed that ownership of a shock wave lithotripter was associated with a three to four times increased likelihood of SWL selection compared with non-ownership, researchers led by Amy E. Krambeck, MD, of Mayo Clinic in Rochester, Minn., concluded.  Increasing time since urologic training, concern for stent pain, and a preference for rigid (versus flexible) ureterscopy were associated with SWL selection. 

When the researchers subjectively assessed patient variables important in clinical decision making, they found that stone composition was considered significantly more often in academic than in community practice. The consideration of stone size and location, patient age and comorbidities, surgical schedule availability, hospital resources, and payer status did not vary between academic and community practice urologists.

“An understanding of the factors influencing the selection of surgical treatment is important in discussing strategies for cost-efficient treatment in a modern healthcare system,” the authors wrote.

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