Emergency upper urinary tract decompression: double-J stent or nephrostomy? A European YAU/ESUT/EULIS/BSIR survey among urologists and radiologists.

PURPOSE: To evaluate the decompression of the pelvicalyceal system between urologists and radiologists. METHODS: A survey was distributed to urologists and to radiologists comparing double-J stent (DJS), percutaneous nephrostomy (PN) and primary ureteroscopy (URS) for three clinical scenarios (1-febrile hydronephrosis; 2-obstruction and persistent pain; 3-obstruction and anuria) before and after reading literature The survey included perception on radiation dose, cost and quality of life (QoL). RESULTS: Response rate was 40% (366/915). 93% of radiologists believe that DJS offers a better QOL compared to 70.6% of urologists (p = 0.006). 28.4% of urologists consider PN to be more expensive compared to 8.9% of radiologists (p = 0.006). 75% of radiologists believe that radiation exposure is higher with DJS as opposed to 33.9% of urologists. There was not a difference in the decompression preference in the first scenario. After reading the literature, 28.6% of radiologists changed their opinion compared to 5.2% of urologists (p < 0.001). The change favored DJS. In the second scenario, responders preferred equally DJS and they did not change their opinion. In the third scenario, 41% of radiologists chose PN as opposed to 12.6% of urologists (p < 0.001). After reading the literature, 17.9% of radiologists changed their opinion compared to 17.9% of urologists (p < 0.001), in favor of DJS. Although the majority of urologists (63.4%) consistently perform primary URS, only 3, 37 and 21% preferred it for the first, second and third scenarios, respectively. CONCLUSION: The decision on the type of drainage of a stone-obstructing hydronephrosis should be individualized.

Decision-Making, Preference, and Treatment Choice for Asymptomatic Renal Stones-Balancing Benefit and Risk of Observation and Surgical Intervention: A Real-World Survey Using Social Media Platform.

Introduction: The burden of kidney stone disease has risen, and several treatment options now exist. We wanted to evaluate the preference and treatment choices based on the information provided for management of hypothetical 8 and 15 mm renal stone, and factors that influenced their decision. Materials and Methods: An online questionnaire to investigate trends in decision-making for two hypothesized scenarios of asymptomatic kidney stones (8 and 15 mm) was formatted online in Microsoft Forms and posted on social media (Facebook) in Europe. The ethical approval was obtained from the University Ethics Committee, and data were collected from general public between September and November 2020. Results: A total of 476 participants of different age and background answered the survey with a male:female ratio of 1:2.7. The age groups were categorized as 18-25 years (n = 149), 26-49 years (n = 192), and 50+ years (n = 135). In the 8 mm scenario, 107 of the 476 participants (22.5%) chose observation, 249 (52.3%) chose extracorporeal shockwave lithotripsy (SWL) and 120 (25.2%) opted for ureteroscopy (URS). In the 15 mm scenario, 194 participants chose SWL treatment (40.8%), 216 (45.4%) URS, and 66 (13.9%) preferred percutaneous nephrolithotomy. The influencing factors were success rate, complication risk and invasiveness of the procedure. On comparison to 8 mm stone, while stent avoidance and activity limitation were considered less important with 15 mm stone (p < 0.001), complication rates were considered more important (p < 0.001). Conclusion: More than one treatment choice for kidney stones often exists and clinicians must take patient choice into account via an informed decision-making process. While some might accept a higher risk of invasiveness and complications for higher stone-free rate, others might have a more conservative approach to this. It is about time that urologists take patient priorities and concerns into account and perhaps use Patient Reported Outcome Measures in addition to clinical outcomes when comparing treatment success.