Trends in ureteropelvic junction obstruction management among urologists in the United States.
OBJECTIVE
To determine current practice patterns in the surgical treatment of ureteropelvic junction obstruction (UPJO) among urologists in the United States.


METHODS
Using the American Urological Association directory, an electronic mail survey regarding the surgical management of UPJO was sent to 1040 urologists in the United States with an electronic mail address listed in the roster.


RESULTS
The response rate was 37.6%. Of the respondents, 67.4% were in community practice and 32.6% in academic practice. Nearly 53% of the respondents would perform a workup for a crossing vessel before definitive therapy; if no crossing vessel was found, 43.5% would consider Acucise endopyelotomy as the first-line procedure. However, if a crossing vessel was found, 57.4% would perform open pyeloplasty and 34.3% would choose laparoscopic pyeloplasty as their first-line procedure. If pyeloplasty was chosen, community urologists preferred open pyeloplasty (77.6%), and academic urologists preferred laparoscopic pyeloplasty (66.9%). The surgeon's training and experience was the most influential factor in choosing between laparoscopic and open pyeloplasty. If the patient had a failed endopyelotomy in the past, most respondents (90.8%) would perform pyeloplasty for definitive treatment of the UPJO.


CONCLUSIONS
Demonstration of a crossing vessel remains an important factor in determining the course of management of a UPJO. During the past 5 years, a growing number of urologists in both academic and nonacademic practices have been performing laparoscopic pyeloplasty for the management of UPJO in adults. Several factors, especially the surgeon's training, have an impact on the choice of procedure. Open pyeloplasty is still performed by a significant number of urologists. These data may be useful in designing physician education programs and/or future investigations to help define standard treatment practices for UPJO.
Tan
Beng Jit
BJ
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA.
Rastinehad
Ardeshir R
AR
Marcovich
Robert
R
Smith
Arthur D
AD
Lee
Benjamin R
BR
D000328:Adult; D019090:Case Management / Q000639:trends*; D003625:Data Collection; D006801:Humans; D007682:Kidney Pelvis / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D010535:Laparoscopy; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012086:Reoperation; D014481:United States; D014513:Ureter / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D014517:Ureteral Obstruction / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000639:trends; D014572:Urology / Q000639:trends*