title: Contemporary Practice Patterns of Flexible Ureteroscopy for Treating Renal Stones: Results of a Worldwide Survey.
abstract: BACKGROUND
  Flexible ureteroscopy (fURS) is increasingly used in the treatment of renal stones. However, wide variations exist in technique, use, and indications. To better inform our knowledge about the contemporary state of fURS for treating renal stones, we conducted a survey of endourologists worldwide.
  
  
  METHODS
  An anonymous online questionnaire assessing fURS treatment of renal stones, consisting of 36 items, was sent to members of the Endourology Society in October 2014. Responses were collected through the SurveyMonkey system over a 3-month period.
  
  
  RESULTS
  Questionnaires were answered by 414 surgeons from 44 countries (response rate 20.7%). U.S. surgeons accounted for 34.4% of all respondents. fURS was routinely performed in 80.0% of institutions, with 40.0% of surgeons performing >100 cases/year. Respondents considered fURS to be first-line therapy for patients with renal stones <2 cm and lower pole calculi. A substantial minority (11.3%) preferred fURS as a primary treatment modality for renal stones >2 cm. Basket displacement for lower pole stones was routinely performed by 55.8%. Ureteral access sheaths (UAS) were preferred for every case by 58.3%. Respondents frequently utilized high-power lasers and dusting techniques. Criteria for determining stone-free rate were defined as zero fragments or residual fragment (RF) <1, <2, <3, and <4 mm by 30.9%, 8.9%, 31.5%, 15.8%, and 11.2% of respondents, respectively.
  
  
  CONCLUSIONS
  The overwhelming majority of endourologists surveyed consider fURS as a first-line treatment modality for renal stones, especially those <2 cm. Use of UAS, high-power holmium lasers, and dusting technique has become popular among practitioners. When defining stone free after fURS, the majority of endourologists used a zero fragment or RF <2 mm definition.
authors.affiliation: 1 Department of Urology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: Casey A
authors.initials: CA
authors.lastname: Dauw
authors.affiliation: 1 Department of Urology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: Laika
authors.initials: L
authors.lastname: Simeon
authors.affiliation: 1 Department of Urology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: Abdulrahman F
authors.initials: AF
authors.lastname: Alruwaily
authors.affiliation: 2 Department of Urology, North Bristol NHS Trust , Bristol, United Kingdom .
authors.forename: Francesco
authors.initials: F
authors.lastname: Sanguedolce
authors.affiliation: 1 Department of Urology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.affiliation: 1 Department of Urology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: William W
authors.initials: WW
authors.lastname: Roberts
authors.affiliation: 1 Department of Urology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Faerber
authors.affiliation: 1 Department of Urology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.affiliation: 1 Department of Urology, University of Michigan Health System , Ann Arbor, Michigan.
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
mesh_terms: D000328:Adult; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000379:methods*; D008875:Middle Aged; D011795:Surveys and Questionnaires; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*; D014572:Urology