Hollowell C M, Patel R V, Bales G T, Gerber G S
Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
J Urol. 2000 Jun;163(6):1779-82.
We determine endourological practice patterns among American urologists for the management of distal ureteral calculi, ureteropelvic junction obstruction, staghorn calculi and the use of ureteral stents with extracorporeal shock wave lithotripsy (ESWLdagger).
Surveys were mailed by the United States postal service to 1,000 American urologists selected randomly from the American Urological Association membership roster. The same survey was sent via the Internet to 3,065 American urologists with an electronic mail address listed in the roster.
Responses were received from 1,029 urologists (postal 601, Internet 428). Ureteroscopy was the preferred treatment for all distal ureteral calculi less than or equal to 10 mm. Acucisedouble dagger endopyelotomy was the most frequently selected therapy for adults with ureteropelvic junction obstruction (50.3%, 514 of 1,022). Open pyeloplasty was recommended by a significantly greater percentage of urologists in practice longer than 15 years compared with the remaining survey respondents (166 of 485, 34.2% versus 92 of 427, 21.5%). For patients with renal pelvic stones 10, 15 or 20 mm. who are treated with ESWL routine stent placement was preferred by 25.3% (259 of 1,022), 57.1% (584 of 1,022) and 87.1% (888 of 1, 019) of urologists, respectively. Percutaneous nephrolithotomy was preferred for patients with staghorn calculi by 80.5% (828 of 1,028) of survey respondents.
Most urologists follow the American Urological Association practice guidelines for patients with distal ureteral calculi and staghorn stones. There is a significant difference of opinion regarding the use of stents with ESWL. No clear consensus has been reached concerning the management of adults with ureteropelvic junction obstruction. These data may be useful in designing physician education programs and/or future investigations to help define standard treatment practices for urological diseases.
我们确定了美国泌尿外科医生在处理远端输尿管结石、输尿管肾盂连接处梗阻、鹿角形结石以及在体外冲击波碎石术（ESWL）中使用输尿管支架方面的腔内泌尿外科实践模式。
美国邮政服务部门将调查问卷邮寄给从美国泌尿外科协会会员名册中随机选取的1000名美国泌尿外科医生。同样的调查问卷通过互联网发送给在名册中列出电子邮件地址的3065名美国泌尿外科医生。
共收到1029名泌尿外科医生的回复（邮寄问卷601份，互联网问卷428份）。输尿管镜检查是治疗所有直径小于或等于10mm的远端输尿管结石的首选方法。对于患有输尿管肾盂连接处梗阻的成年人，冷刀内切开术是最常选择的治疗方法（50.3%，1022例中的514例）。与其他调查对象相比，从业超过15年的泌尿外科医生中，推荐开放性肾盂成形术的比例显著更高（485例中的166例，34.2%；427例中的92例，21.5%）。对于直径为10mm、15mm或20mm的肾盂结石且接受ESWL治疗的患者，分别有25.3%（1022例中的259例）、57.1%（1022例中的584例）和87.1%（1019例中的888例）的泌尿外科医生倾向于常规放置支架。80.5%（1028例中的828例）的调查对象认为经皮肾镜取石术是治疗鹿角形结石患者的首选方法。
大多数泌尿外科医生遵循美国泌尿外科协会针对远端输尿管结石和鹿角形结石患者的实践指南。在ESWL中使用支架方面存在显著的意见分歧。关于成年输尿管肾盂连接处梗阻的治疗尚未达成明确共识。这些数据可能有助于设计医生教育项目和/或未来的研究，以帮助确定泌尿外科疾病的标准治疗方法。
