Table 3.
Summary of survey results
| Department bed capacity <20 beds 20–40 beds >40 beds |
47 111 51 |
22.49% 53.11% 24.40% |
| Offered types of stone treatment SWL sURS fURS PCNL |
136 189 173 171 |
65.07% 90.43% 82.78% 81.82% |
| Type of SWL service We have a fixed-site SWL machine We have access to a mobile SWL machine We refer patients to another hospital for SWL We do not offer SWL |
128 13 23 45 |
61.24% 6.22% 11.00% 21.53% |
| SWL performed by… Trained Urologist Resident Technician |
124 69 81 |
59.33% 33.01% 38.76% |
| In the primary setting renal colic patients are treated by… GP Private urologist Hospital urologist |
68 23 118 |
32.54% 11.00% 56.46% |
| Number of renal colic patients treated per day <5 5–10 10–20 >20 |
89 94 18 8 |
42.58% 44.98% 8.61% 3.83% |
| Urolithiasis patients treated per week 0–5 5–10 10–15 15–20 >20 |
31 58 52 28 40 |
14.83% 27.75% 24.88% 13.40% 19.14% |
| Diagnostic imaging strategy for renal colic in the acute setting Xray – KUB Kidney / Bladder Ultrasound Kidney / Bladder Ultrasound + NCCT Xray – KUB + Kidney / Bladder Ultrasound NCCT Xray-KUB + NCCT Xray-KUB + Kidney / Bladder Ultrasound + NCCT |
7 14 63 32 62 7 24 |
3.35% 6.70% 30.14% 15.31% 29.67% 3.35% 11.48% |
| Specific guidelines applied in colic patient diagnosis and treatment (more than one option is possible) Yes, EAU guidelines Yes, National guidelines According to surgeon preference No, we follow our institution / department regulations |
176 38 46 14 |
84.21% 18.18% 22.01% 6.70% |
| Use of MET Yes, always No, we never use it Doctor preference |
115 12 82 |
55.02% 5.74% 39.23% |
| Admission of renal colic patients Yes always, except when patients refuse it Yes, if there are free beds Patient preference Urologist preference No, only when there is an absolute indication (resistant pain, sepsis, renal insufficiency) |
34 11 3 25 136 |
16.27% 5.26% 1.44% 11.96% 65.07% |
| Reasons for renal colic patient admission (more than one option is possible) We always have beds for them It is a standard treatment, according to my Institution/ department regulations Our goal is to manage the colic and if stone diagnosed to treat it at the same time Financial reasons / Insurance issues They cannot be treated elsewhere |
10 19 18 4 5 |
22.22% 42.22% 40.00% 8.89% 11.11% |
| Most common treatment strategy in case of patient admission Conservative treatment until patient symptom-free, if no relief offer minimally invasive management Conservative treatment until a spontaneous stone passage 1–2 days conservative treatment, if no spontaneous stone passage then offer minimally invasive management Direct minimally invasive management (emergency URS or SWL) According to doctor preference According to patient preference |
73 3 56 17 17 5 |
42.69% 1.75% 32.75% 9.94% 9.94% 2.92% |
| Common minimally invasive management strategy of renal colic for a ureteral stone Primary SWL Insertion of DJ stent with the intention to push stone in the kidney and planning of secondary treatment with SWL Insertion of DJ stent and planning of secondary treatment with sURS or fURS Primary sURS under general anesthesia. If failure DJ insertion and planning of secondary treatment Surgeon preference Patient preference |
21 7 65 57 19 2 |
12.28% 4.09% 38.01% 33.33% 11.11% 1.17% |
| Encountered complications in active renal colic treatment Sepsis Acute Kidney Injury Urinoma Ureteral injury / stenosis |
129 59 4 17 |
61.72% 28.23% 1.91% 8.13% |
| Type of applied anesthesia for DJ stent insertion General anesthesia Sedation Regional/Spinal anesthesia Local anesthesia By men always general anesthesia, by women local anesthesia Patient preference Doctor preference |
89 69 51 31 12 8 9 |
52.05% 40.35% 29.82% 18.13% 7.02% 4.68% 5.26% |
| Reasons for avoiding admission of renal colic patients Not enough beds Admission is not a standard treatment, according to my Institution / department regulations The goal is for the stone to be treated in a second session/admission Financial reasons |
62 90 35 13 |
36.26% 52.63% 20.47% 7.60% |
| Follow up of patients during the whole treatment Yes, always Yes, but only if we can offer the treatment needed (SWL, fURS, PCNL) otherwise patients are admitted elsewhere No, we just treat the acute problem Surgeon preference Patient preference |
125 24 10 5 7 |
73.10% 14.04% 5.85% 2.92% 4.09% |
| Length of DJ stent placement after URS <1 week 1–2 weeks 2–4 weeks >4weeks If patient pre-stented and/or uncomplicated URS, one day If patient pre-stented and/or uncomplicated URS, no stent Surgeon preference |
23 75 65 16 18 33 11 |
13.45% 43.86% 38.01% 9.36% 10.53% 19.30% 6.43% |
| Benefits of a primary URS in stone treatment Colic and stone are treated in one session Need to decrease future general anesthesia Less patient discomfort/stress Less administrative/secretary work (planning of appointments etc.) No benefits No opinion Financial benefits /insurance issues (please explain) |
149 43 86 36 5 6 5 |
87.13% 25.15% 50.29% 21.05% 2.92% 3.51% 2.92% |
| Drawbacks of a primary URS stone treatment Needs more surgeon experience Very often unsuccessful, patients undergo a second treatment anyway High complication rates An emergency operation plan often not accomplished No drawbacks No opinion Financial drawbacks / insurance issues (explain) |
73 28 27 58 28 7 5 |
42.69% 16.37% 15.79% 33.92% 16.37% 4.09% 2.92% |
GP – general practitioner; SWL – shock wave lithotripsy; URS – ureteroscopy; sURS – semi-rigid ureterocopy; fURS – flexible ureteroscopy; PCNL – percutaneous nephrolithotripsy; KUB – kidney ureter bladder; NCCT – non-contrast computer tomography; MET – medical expulsive therapy; DJ– double-J stent