Wertheim Margaret L, Nakada Stephen Y, Penniston Kristina L
1 Department of Urology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
J Endourol. 2014 Sep;28(9):1127-31. doi: 10.1089/end.2014.0164. Epub 2014 Jun 30.
To assess urologists' practice patterns and beliefs about dietary therapy for stone prevention. Dietary therapy is offered to stone formers (SFs) by a subset of urologists. While some may involve a registered dietitian (RD) to provide medical nutrition therapy (MNT), most do not as MNT is Medicare-covered only for diabetes and chronic kidney disease.
An investigator-created survey was distributed to assess Endourological Society members' opinions, confidence, and practices regarding nutrition therapy.
Respondents (n=217) practice largely in academic, hospital/clinic, and private settings. Most (82%) felt dietary therapy should be provided regardless of the number of stone events. Most (90%) said the urologist should provide dietary recommendations and more than half (52%) do so for ≥75% of patients (10% provide it for <25%). Time spent with SFs for nutrition varied from ≤4 to ≥10 minutes (31% and 23%) with 64% feeling this to be insufficient time. Of urologists providing counseling, 58% assess their patients' diets. Self-confidence in determining dietary contributors to risk factors and in quantifying intake of foods/nutrients varied (range 45%-82%). Most (76%) said they would like another provider to give recommendations; 23% partner with an RD to do so.
Urologists are interested in dietary stone prevention, despite the fact that the majority have inadequate time to provide it. We identified areas of educational need, specifically, quantifying patients' intake of certain foods/nutrients and identifying whether stone risk factors are diet related. Urologists' skill gaps are precisely the strengths of RDs, and thus, a partnership between RDs and urologists could be beneficial.
评估泌尿外科医生对于结石预防饮食疗法的实践模式和看法。一部分泌尿外科医生会为结石形成者（SFs）提供饮食疗法。虽然有些医生可能会让注册营养师（RD）提供医学营养治疗（MNT），但大多数医生不会这样做，因为MNT仅在医疗保险中涵盖糖尿病和慢性肾病。
分发一份由研究者创建的调查问卷，以评估腔内泌尿外科协会成员关于营养治疗的意见、信心和实践情况。
受访者（n = 217）大多在学术机构、医院/诊所和私人诊所执业。大多数（82%）认为无论结石发作次数多少都应提供饮食疗法。大多数（90%）表示泌尿外科医生应提供饮食建议，超过一半（52%）的医生为≥75%的患者提供建议（10%的医生为<25%的患者提供建议）。与SFs讨论营养问题的时间从≤4分钟到≥10分钟不等（分别为31%和23%），64%的医生认为这个时间不够。在提供咨询的泌尿外科医生中，58%会评估患者的饮食。在确定饮食对风险因素的影响以及量化食物/营养素摄入量方面的自信程度各不相同（范围为45%-82%）。大多数（76%）表示希望有其他医疗人员给出建议；23%的医生与注册营养师合作来提供建议。
尽管大多数泌尿外科医生没有足够时间提供饮食疗法，但他们对预防结石的饮食疗法感兴趣。我们确定了教育需求领域，具体而言，量化患者对某些食物/营养素的摄入量以及确定结石风险因素是否与饮食有关。泌尿外科医生的技能差距正是注册营养师的优势所在，因此，注册营养师与泌尿外科医生之间的合作可能会有益。
