title: Management behaviors of the urology practitioners to the small lower calyceal stones: the results of a web-based survey.
abstract: Lower pole calyceal stones (LPS) represent lower spontaneous passage rates and, therefore, require several interventional treatment approaches. The aim of this survey study was to investigate the attitudes of the urology practitioners and the factors affecting their decision making in the management of small asymptomatic LPS. A total of 149 urologists participated to the study via email through the internet-based website. Participating urologists were asked to complete a 29-question survey including personal and academic data, level of surgical experience, available equipment for interventional approaches, which treatment do they prefer for small LPS (≥5 mm and <1 cm), and factors affecting their treatment decision. All data were analyzed to make inferences related with treatment decision and factors affecting decision-making. Mean participant age was 41.57 (26-62) years. The most preferred approach was observation/medical treatment option (52.3 %), subsequently SWL (25.5 %), RIRS (16.1 %), miniPNL (5.4 %) and standard PNL (0.7 %) were chosen by the participants. On the other side, SWL and medical treatment were at the forefront (52 and 16.1 %) among children. In the multivariate analysis of participants' age, academic status, surgical experience and institution, none was significantly associated with treatment decision-making (p > 0.05). The most important factors associated with decision making were calyceal dilatation (85.9 %) and patient preferences (81.2 %). The other factors effecting treatment decision were reported to be recurrent disease (70.5 %), the duration of the stone (74.5 %), patient age (95.3 %), current guidelines (87.9 %), stone density (50.3 %), body mass index (BMI) (73.8 %) and other morbid diseases (91.9 %). Our surveys' greatest value is in demonstrating the preferred treatment options and factors effecting decision-making in the treatment of LPS. The most preferred option in our population was follow-up and medical treatment. The most influencing factors on decision-making were age, patients' preferences, presence of calyceal dilatation, body mass index, comorbid conditions, available options for stone treatment and the surgeon's experience on the existing opportunities.
authors.affiliation: Department of Urology, GMMA Haydarpasa Research and Training Hospital, Uskudar, Istanbul, Turkey.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Ates
authors.affiliation: Department of Urology, GMMA Haydarpasa Research and Training Hospital, Uskudar, Istanbul, Turkey. murat804@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Zor
authors.affiliation: Department of Urology, GMMA Haydarpasa Research and Training Hospital, Uskudar, Istanbul, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Yılmaz
authors.affiliation: Urology Department, Kartal Research and Training Hospital, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Tuncer
authors.affiliation: Urology Department, Haydarpasa Research and Training Hospital, Istanbul, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Ozturk
authors.affiliation: Urology Department, Medeniyet University, Istanbul, Turkey.
authors.forename: Cenk
authors.initials: C
authors.lastname: Gurbuz
authors.affiliation: Urology Department, Medeniyet University, Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Atis
authors.affiliation: Urology Department, Haydarpasa Research and Training Hospital, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Koca
authors.affiliation: Urology Department, Medeniyet University, Istanbul, Turkey.
authors.forename: Asif
authors.initials: A
authors.lastname: Yildirim
authors.affiliation: Urology Department, Kartal Research and Training Hospital, Istanbul, Turkey.
authors.forename: Bilal
authors.initials: B
authors.lastname: Eryildirim
authors.affiliation: Urology Department, Umraniye Research and Training Hospital, Istanbul, Turkey.
authors.forename: Eyup Veli
authors.initials: EV
authors.lastname: Kucuk
authors.affiliation: Urology Department, Kartal Research and Training Hospital, Istanbul, Turkey.
authors.forename: Fehmi
authors.initials: F
authors.lastname: Narter
authors.affiliation: Department of Urology, GMMA Haydarpasa Research and Training Hospital, Uskudar, Istanbul, Turkey.
authors.forename: Temucin
authors.initials: T
authors.lastname: Senkul
authors.affiliation: Urology Department, Kartal Research and Training Hospital, Istanbul, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Sarica
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D007669:Kidney Calculi / Q000473:pathology / Q000628:therapy*; D007670:Kidney Calices; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014572:Urology
keywords: Management behaviors; PNL; RIRS; SWL; Small lower calyceal stones; Web-based survey