Contemporary management of ureteropelvic junction obstruction: practice patterns in Minnesota.
OBJECTIVE
Ureteropelvic junction (UPJ) obstruction can be addressed surgically by an open, laparoscopic, endoscopic, or fluoroscopic procedure. Our objective was to establish what surgical alternatives are currently offered by urologists in Minnesota.


METHODS
A questionnaire was sent to 174 members of the Minnesota Urological Society. Practice settings were characterized as rural, urban, or metropolitan on the basis of the ZIP-code classifications of the Minnesota Ambulance Association and state geographic legislation. Respondents were asked to select initial treatment options for an adult patient with flank pain, decreased renal function, and hydronephrosis secondary to UPJ obstruction.


RESULTS
Whereas 60% of the respondents would offer open pyeloplasty, only 12% would offer it as the only treatment option. The two most common minimally invasive therapies offered were the Acucise balloon (48%) and percutaneous antegrade endopyelotomy (48%). Rural urologists were more likely to offer Acucise balloon incision (71%) than were urban (28%; P=0.045) or metropolitan (55%; P=0.412) urologists.


CONCLUSIONS
The majority of urologists still offer open pyeloplasty as first-line therapy for UPJ obstruction. Further emphasis should be placed on increasing the availability of endoscopic and laparoscopic procedures.
Fallon
Elizabeth
E
Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Ercole
Barbara
B
Lee
Courtney
C
Best
Sara
S
Skenazy
Jason
J
Monga
Manoj
M
D000328:Adult; D019090:Case Management / Q000706:statistics & numerical data; D003657:Decision Making; D004724:Endoscopy / Q000379:methods; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008910:Minnesota; D010818:Practice Patterns, Physicians'; D011365:Professional Practice Location / Q000706:statistics & numerical data; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014572:Urology