Use of flexible ureteroscopy in the clinical practice for the treatment of renal stones: results from a large European survey conducted by the EAU Young Academic Urologists-Working Party on Endourology and Urolithiasis

Abstract

Treatment of renal stones using flexible ureteroscopy (fURS) is increasingly common despite the poor evidence in literature supporting its use and indications. With this study, we wanted to investigate the current use and indication of fURS for the treatment of renal stones in the clinical practice across the European countries. A survey was conducted using an emailed questionnaire consisting of 21 items; 2,894 recipients were selected via the EAU membership database. The questionnaires were collected through the SurveyMonkey system and the data were processed with the SPSS statistical package. Frequencies, cross tabs and Pearson correlation coefficients were applied as appropriate. 1,168 questionnaires were collected (response rate 40.4%). fURS was performed in 72.9% of the respondents' institutions, and 54.2% of the respondents were performing the procedure. For 95% of the users, fURS was considered first-line treatment, for stone of lower pole stone (45.9%) and <1 cm (44.2%) and 2 cm (43.8%) in size. The ureteral access sheaths were used routinely by more than 70% of the respondents. Lower pole stone repositioning technique was routinely performed by 45.9% of the surgeons. After fragmentation, 47.2% of the responders preferred to retrieve only the bigger fragments. At the end of fURS, lower volume surgeons were more likely to place routinely a double-J stent (p = 0.001). Higher volume surgeons estimated a higher durability of devices, both optical and digital ones (p < 0.001), and were more prone to consider fURS cost-effective when compared to other treatment modalities (p < 0.001). fURS is widely used for the treatment of renal stones and its use and indication can vary according to the age and surgeons' case volume. Higher volume surgeons are more prompt to extend international guidelines indications and to consider the technology cost-effective.

What is the stone-free rate following flexible ureteroscopy for kidney stones?

“…In a survey of flexible URS practice patterns among urologists conducted by the EAU, a UAS was preferred by 71% and approximately 50% of all respondents reported retrieval of larger fragments using such an approach. 63 This survey also found that senior urologists were less likely to perform retrieval than younger urologists. Nevertheless, whether or not active retrieval actually improves the SFR in patients under going stone surgery remains unproven.…”

Contemporary Practice Patterns of Flexible Ureteroscopy for Treating Renal Stones: Results of a Worldwide Survey

“…1 Despite recent population-level evidence demonstrating increasing utilization of fURS, [2][3][4] little information exists on contemporary practice patterns of fURS for the treatment of renal calculi. 5 While guidelines recommend fURS for treating renal stones <1.5 cm, 6 considerable differences exists among urologists in the technique, use, and indications of fURS. In particular, the variation in the use of disposable equipment, such as ureteral access sheaths (UAS) or nitinol retrieval devices, and the utilization of more powerful high-watt holmium laser systems in the modern era of fURS, have not been thoroughly evaluated.…”

“…Recently, the European Association of Urology (EAU) conducted a survey on the use of fURS for the treatment of renal calculi in Europe. 5 To study a broader collection of urologists throughout the world, we modified this questionnaire and surveyed members of the Endourology Society about multiple facets of renal calculi treatment using fURS. Our specific aim was to explore differences in the fURS technique and practice among endourologists.…”

Comparison of Postoperative Fever and Effectiveness of Percutaneous Nephrolithotomy (PCNL) Versus Retrograde Intrarenal Surgery (RIRS) for the Treatment of Renal Stones

“…Percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are two common and widely used alternative interventions for the treatment of renal stones. Flexible Institute of Computational Science, Universita della Svizzera Italiana, 6900 Lugano, Switzerland ureteroscopy by RIRS is a popular intervention for the treatment of renal stones, and it has been widely used over the last two decades, particularly in Europe [7].The 2014 Urolithiasis Guideline of the European Association of Urology prescribes PCNL as the preferred treatment for renal stones over 2 cm in stone diameter [8], as it has high stone-free rates. However, it has been observed that PCNL in certain cases also lead to a high risk of postoperative fever, such as sepsis, which is a life-threatening and complicated infection.…”