Current scenario of endourological treatment of kidney stones in brazil: results of a national survey

ABSTRACT Objective: To elucidate the current scenario of endourology in Brazil for the treatment of urinary lithiasis, with an emphasis on regional differences and the reasons why certain techniques are still underutilized. Materials and Methods: An electronic questionnaire was sent by email to the 4,745 members of the Brazilian Urological Society (BSU) in 2016 to collect information on the 3 main endourological procedures used in the treatment of nephrolithiasis: Semi-rigid ureteroscopy (URS), Flexible ureteroscopy (F-URS) and percutaneous nephrolithotripsy (PCNL). Results: A total of 1,267 urologists answered the questionnaire. It was observed that the vast majority perform URS (95.6%), while 80.2% perform F-URS and only 72.1% perform PCNL. Regarding the surgical volume, most perform up to 10 procedures per month (73.4% to 88.2%) and the main impediment was the lack of patients with the pathology (42.1% to 67.7%). The lack of equipment or hospital infrastructure was one of the main limiting factors for rigid (23%) and flexible (38.1%) URS, mainly in the North and Northeast regions of the country. Regarding PCNL, most of them reported lack of practical experience in the method (29.9%). Finally, most urologists expressed interest in taking courses in endourology. Conclusion: Ureteroscopy, rigid or flexible, is already well established in the country, requiring the direction of more resources for its practice, especially in less developed regions. Regarding PCNL a significant part of Brazilian urologists still lack practical experience in this procedure, emphasizing the need for greater investment in teaching this technique.

摘要 研究目的：阐明巴西泌尿腔内技术治疗尿路结石的临床现状，重点分析区域差异及部分技术仍未得到充分推广应用的原因。材料与方法：2016年，本研究通过电子邮件向巴西泌尿外科学会（Brazilian Urological Society, BSU）的4745名会员发送电子问卷，收集当前用于治疗肾结石的3种主流泌尿腔内手术的相关信息：半硬性输尿管镜检查（Semi-rigid ureteroscopy, URS）、软性输尿管镜检查（Flexible ureteroscopy, F-URS）以及经皮肾镜碎石术（percutaneous nephrolithotripsy, PCNL）。结果：本研究共回收1267份泌尿外科医师有效问卷。数据显示，绝大多数医师开展半硬性输尿管镜检查（占比95.6%），80.2%的医师开展软性输尿管镜检查，仅72.1%的医师开展经皮肾镜碎石术。在手术量分布上，多数医师每月开展此类手术不超过10例（占比73.4%~88.2%）；最主要的临床开展阻碍因素为缺乏对应病理患者（占比42.1%~67.7%）。对于半硬性与软性输尿管镜检查而言，设备匮乏或医院基础设施不足是主要限制因素之一（分别占比23%与38.1%），该情况在巴西北部及东北部地区尤为显著。针对经皮肾镜碎石术，多数医师表示自身缺乏该术式的实操经验（占比29.9%）。最后，绝大多数受访泌尿外科医师表示有意愿参加泌尿腔内相关专业培训课程。结论：半硬性或软性输尿管镜检查在巴西已得到广泛普及，但仍需为其临床应用调配更多资源，尤其是在欠发达地区。对于经皮肾镜碎石术而言，仍有相当一部分巴西泌尿外科医师缺乏该术式的实操经验，凸显了加大该技术教学培训投入的必要性。