title: Changes in Urolithiasis Referral Patterns for Shock Wave Lithotripsy over a Decade: Was There Adherence to AUA/EAU Guidelines?
abstract: OBJECTIVE
  The primary objective was to assess changes in referral patterns of urolithiasis for shock wave lithotripsy (SWL) over a decade. The secondary objective was to evaluate the effect of the number of years of practice of referring physicians on these referral patterns.
  
  
  METHODS
  A retrospective review of SWL database was performed for consecutive referrals for SWL at a tertiary stone center between December 1999 and December 2013. Patient demographics and stone characteristics were assessed. The stone location at the time of referral was used as the reference. Retreatments were excluded. In addition, years of practice of the referring physicians were calculated. The 2007 AUA/EAU guidelines on urolithiasis were considered as a reference.
  
  
  RESULTS
  A total of 8,992 SWL treatments were included. After December 2007, there was a significant increase in the percentage of renal pelvic stones referred for SWL (23.0 vs. 27.1%, p < 0.001). Conversely, proximal ureteral stones significantly decreased after 2007 (24 vs. 18.2%, p < 0.001) including stones > 10 mm (5.1 vs. 2.9%, p < 0.001). Otherwise, there were no changes in the referral patterns for SWL of other stone locations before and after December 2007 (p > 0.05). Furthermore, percentage of stones referred for SWL by urologists practicing for less than 10 years significantly decreased after December 2007 (29.5 vs. 22.8%, p < 0.001).
  
  
  CONCLUSIONS
  The significant reduction in the referral of proximal ureteral stones after December 2007 corresponds to the latest AUA/EAU guidelines on management of ureteral stones.
authors.affiliation: Division of Urology, McGill University Health Centre, Montreal, Québec, Canada; Department of Urology, Benha University Hospital, Benha University, Benha, Egypt.
authors.forename: Yasser A
authors.initials: YA
authors.lastname: Noureldin
authors.affiliation: Division of Urology, McGill University Health Centre, Montreal, Québec, Canada; Department of Urology, Suez Canal University, Ismailia, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.affiliation: Division of Urology, McGill University Health Centre, Montreal, Québec, Canada.
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
keywords: Guidelines; Lithotripsy; Referral; Shock waves; Urolithiasis