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Background:
The surgical management of renal and ureteral stones is often dependent on the urologist’s preference, training background, and type of practice. A shift towards ureteroscopy with laser lithotripsy has been noted in academic centers, whereas extracorporeal shock wave lithotripsy (ESWL) remains a mainstay in the private sector. We sought to determine the practice patterns of urologists in the New England area with regard to surgical management of nephrolithiasis.
Methods:
A survey was constructed regarding training background, practice description, ownership of ESWL machine, and 5 clinical scenarios with computed tomography images of patients with stones. The case scenarios were: 1) 1 cm calculus in the renal pelvis, 2) 1.5 cm lower pole renal calculus, 3) 5 mm distal ureteral stone without hydronephrosis, 4) 7 mm proximal ureteral stone with mild hydronephrosis, and 5) bilateral 1 cm stones (right lower pole, left renal pelvis). The survey was sent to the 445 members of the New England section of the AUA with valid email addresses.
Results:
The overall response rate was 17% (75/445). 44% of respondents were in academics and 12% were fellowship trained in endourology. Ownership of ESWL machine was reported in one third of all responders (80% of private urologists and 20% of academic urologists). 46% believed usage of ESWL had decreased in the last 5 years, and 46% believed usage had remained the same. Only 8% of respondents stated that ESWL had increased in use. 66% of respondents believed that ureteroscopy (URS) had increased in the last 5 years, and 31.5% believed it had remained the same. 2.7% believed that URS had decreased. The case scenario results are listed in Table 1. Interestingly, 88% of private urologists preferred ESWL in case 1 compared to 25% of academic urologists. 72% of academic urologists preferred URS compared to 9% of private urologists. There was no difference seen with respect to ESWL usage based on ownership of ESWL machine.
Conclusions:
Most urologists in New England feel that the use of URS is increasing and the use of ESWL is decreasing or remaining the same. The usage of each treatment modality is dependent most on the clinical scenario. In our case scenarios, private urologists were more likely to choose ESWL compared to academic urologists. However, ownership of ESWL machine did not affect the choice of treatment.
Table 1. Responses to Clinical Scenarios

	ESWL	URS	PCNL
Case 1	58.6% (41)	38.6% (27)	7.1% (5)
Case 2	11.9% (8)	26.9% (18)	61.2% (41)
Case 3	4.5% (3)	95.5% (64)	0.0% (0)
Case 4	31.3% (20)	68.8% (44)	0.0 (0)
Case 5	44.4% (28) (staged)	27.0% (17) (staged)	1.6% (1) (staged)