title: Shockwave Lithotripsy Practice Pattern Variations Among and Between American and Canadian Urologists: In Support of Guidelines.
abstract: Shockwave lithotripsy (SWL) is a widely utilized form of treatment for urolithiasis. There are new evidence-based recommendations regarding pre-SWL patient work-up and the performance of SWL. The purpose of this study is to determine practice patterns for SWL and to determine if regional variation exists between Canada and the United States.
  
  
  
  A 19-question survey was prepared. Canadian urologists were surveyed through e-mail correspondence. In the United States, members of the Endourologic Society and members of two large stone management groups were surveyed. Canadian and American results were compared using the chi-square and Fisher's exact tests.
  
  
  
  Ninety-four Canadian urologists and 187 U.S. urologists completed the survey. Practice patterns differed between countries. Intravenous sedation was more commonly used in Canada (Canada 94.7% vs United States 17.9%, p < 0.001); routine antibiotics were more commonly given in United States (Canada 2.1% vs United States 78.1%, p < 0.001); a shock rate of 2 Hz was more common in Canada (Canada 76.6% vs United States 16.2%, p < 0.00001); rate of discontinuing ASA for renal and ureteral stone treatment was higher in the United States (renal Canada 88.3% vs United States 95.7%, p < 0.02; ureteral Canada 62.4% vs 90.3%, p < 0.0001); and ureteral stents were more commonly used if treating a large stone or patients with solitary kidneys in the United States (large stones Canada 58.2% vs United States 88.8%, p = 0.0001; solitary kidney Canada 50.6% vs 66.3%, p = 0.02).
  
  
  
  This study highlights the absence of standardization of SWL. Significant regional differences exist in practice patterns and performance of SWL between Canadian and American urologists.
authors.affiliation: 1 Department of Urology, Dalhousie University , Halifax, Nova Scotia, Canada .
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Lantz
authors.affiliation: 1 Department of Urology, Dalhousie University , Halifax, Nova Scotia, Canada .
authors.forename: Jeffrey
authors.initials: J
authors.lastname: McKay
authors.affiliation: 2 Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto , Canada .
authors.forename: Michael
authors.initials: M
authors.lastname: Ordon
authors.affiliation: 2 Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto , Canada .
authors.forename: Kenneth T
authors.initials: KT
authors.lastname: Pace
authors.affiliation: 3 Department of Urology, Cleveland Clinic , Cleveland, Ohio.
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.affiliation: 2 Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto , Canada .
authors.forename: R John D'A
authors.initials: RJ
authors.lastname: Honey
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001241:Aspirin / Q000627:therapeutic use; D002170:Canada; D016292:Procedural Sedation / Q000379:methods; D000069340:Deprescriptions; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D007669:Kidney Calculi / Q000150:complications / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015607:Stents; D011795:Surveys and Questionnaires; D014481:United States; D014514:Ureteral Calculi / Q000150:complications / Q000628:therapy*; D018666:Ureteroscopy; D014564:Urogenital Abnormalities / Q000150:complications; D052878:Urolithiasis / Q000628:therapy; D000072178:Urologists
chemical_list: D000900:Anti-Bacterial Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin