title: Factors influencing urologist treatment preference in surgical management of stone disease.
abstract: OBJECTIVE
  To assess the surgeon factors influencing the surgical treatment decisions for symptomatic stone disease. The factors influencing the selection of shock wave lithotripsy (SWL), ureteroscopy, or percutaneous nephrolithotomy to treat symptomatic stone disease are not well studied.
  
  
  METHODS
  Electronic surveys were sent to urologists with American Medical Association membership. Information on training, practice, and ideal treatment of common stone scenarios was obtained and statistically analyzed.
  
  
  RESULTS
  In November 2009, 600 surveys were sent and 180 were completed. High-volume SWL practices (>100 cases annually) were more common in community practice (P < .01), and high-volume ureteroscopy and percutaneous nephrolithotomy practices were more common in academic practice (P = .03). Community practice was associated with SWL selection for proximal urolithiasis and upper pole nephrolithiasis (P < .005). An increasing time since urologic training was associated with SWL selection for proximal urolithiasis and upper pole nephrolithiasis (P < .01). Urologists reporting shock wave lithotriptor ownership were 3-4 times more likely to select SWL for urolithiasis or nephrolithiasis compared with urologists who did not own a lithotripter (P < .01). Routine concern for stent pain and rigid ureteroscope preference (vs flexible) were associated with SWL selection (P < .03).
  
  
  CONCLUSIONS
  Surgeon factors significantly affected urolithiasis treatment selection. SWL was associated with community urology practice, increasing time since training, shock wave lithotriptor ownership, concern for stent pain, and ureteroscope preference.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: M Adam
authors.initials: MA
authors.lastname: Childs
authors.forename: Laureano J
authors.initials: LJ
authors.lastname: Rangel
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D003625:Data Collection; D006801:Humans; D008096:Lithotripsy / Q000706:statistics & numerical data; D008875:Middle Aged; D053040:Nephrolithiasis / Q000628:therapy; D009403:Nephrostomy, Percutaneous / Q000706:statistics & numerical data; D010067:Ownership / Q000706:statistics & numerical data; D010146:Pain / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D014481:United States; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000706:statistics & numerical data; D052878:Urolithiasis / Q000628:therapy*; D014572:Urology / Q000193:education / Q000706:statistics & numerical data*